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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207603
Report Date: 12/01/2021
Date Signed: 12/01/2021 01:26:01 PM


Document Has Been Signed on 12/01/2021 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:UPWARD BOUND PRE-SCHOOLFACILITY NUMBER:
426207603
ADMINISTRATOR:DEBORAH MADISSONFACILITY TYPE:
850
ADDRESS:1040 PATTERSON RD.TELEPHONE:
(805) 938-5121
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:60CENSUS: 22DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Deborah MadissonTIME COMPLETED:
01:30 PM
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On December 1, 2021, Licensing Program Analysts (LPAs) Gigi Reyes and Dean Thompson met with Director Deborah Maddison and explained the purpose of the inspection. Prior to inspection LPAs asked health screening questions related to COVID-19, Director's responses indicate there are no COVID 19 exposures on site. There were 22 day care children and 5 staff present including the Director during the inspection. The center operates from 7:00 AM to 5:15 PM

During the tour, the following were observed, required licensing forms are posted by the entrance door. The Center has 2 buildings, Classrooms in each building are adequately equipped with age and size appropriate furniture and equipment. Water pitcher and water fountain supply drinking water in the indoor activity space. Playground is enclosed by an appropriate fence. Outdoor activity area is equipped with age and size appropriate equipment. An adequate amount of cushioning material, wood chips are in place under play equipment. There is an adequate shade in the play ground. Drinking water is provided in the outdoor play area by water pitcher and paper cups are provided.

Sign-in/out logs were reviewed and found complete. Children files were reviewed and found complete. Director and Teachers files were reviewed. Review of files revealed that Staff 1 does not have Criminal Record Clearance. Staff present have current Pediatric First Aid/CPR certificates that expire on 11/2022. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Facility is following current Covid-19 guidelines.

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SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: UPWARD BOUND PRE-SCHOOL
FACILITY NUMBER: 426207603
VISIT DATE: 12/01/2021
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.



Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During today's inspection deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

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SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: UPWARD BOUND PRE-SCHOOL
FACILITY NUMBER: 426207603
VISIT DATE: 12/01/2021
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The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2022 04:27 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/23/2021 04:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: UPWARD BOUND PRE-SCHOOL
FACILITY NUMBER: 426207603

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Criminal Record Clearance
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above, Staff 1 does not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2021
Plan of Correction
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Director sent home the Staff during the inspection. Director will submit a written POC to ensure that all staff have criminal record clearance prior to working in the Center

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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