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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208408
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:40:02 PM

Document Has Been Signed on 10/31/2024 03:40 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KOWALEWSKI FAMILY CHILD CAREFACILITY NUMBER:
426208408
ADMINISTRATOR/
DIRECTOR:		SHELLY KOWALEWSKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 737-9872
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Shelly KowalewskiTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 10/31/24, at 1:20 PM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced Annual Random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Shelly Kowalewski, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a 3-bedroom and 2-bathroom single-story home. The FCCH utilizes the family room, dining room, kitchen, one bathroom, playroom, and front yard, while the remainder of the home is excluded (3 bedrooms, 1 bathroom, backyard, and garage). At the time of the inspection, 6 children were present along with the Licensee's Husband (cleared and associated) and a parent for a short time.

LPA observed the FCCH to be orderly and clean. The bathroom, utilized for childcare services, is clean, orderly, and free of toxins. Each bathroom cabinet is made secure by child safety latches. Sharps were observed in an elevated kitchen cabinet. Personal medication is kept in an excluded bedroom closet in a secure lockbox. Cleaning supplies were stored in an elevated laundry room cabinet out of reach of children in care. Importantly to note, the living room possesses a fireplace that is made secure by a heavy duty metal screen. Licensee informed LPA that the fireplace is not utilized during day care hours. The Licensee attested to the LPA that the FCCH possesses a First Aid Kit.

LPA observed age-appropriate books, toys, and other furnishings throughout the interior of the FCCH (living room and playroom areas).

LPA observed appropriate licensing forms and documents posted prominently to a bulletin board in the FCCH. LPA observed a number of smoke and carbon monoxide detectors throughout the FCCH. Due to children in care sleeping at the time of the inspection, the detectors were not tested, but were verbally confirmed by the Licensee to be operational.

LPA also observed a regulation fire extinguisher in the FCCH, which was serviced on 6/6/24. (CONT. 809-C, Page 2)

Maria MuellerTELEPHONE: (805) 562-0400
Matthew SapienTELEPHONE: (805) 562-0400
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KOWALEWSKI FAMILY CHILD CARE
FACILITY NUMBER: 426208408
VISIT DATE: 10/31/2024
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LPA reminded the Licensee to service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH's fire/disaster drill log. The most recent fire drill occurred on 10/21/24. Licensee informed LPA that the FCCH conducts disaster drills every month.

As previously noted, the front yard is accessible to children in care. The FCCH's front yard is enclosed by secure wooden fencing and brick walls. The fence’s entry/exit points are secure. As is the case with the interior of the FCCH, the outdoor area has age-appropriate play structures, toys, furnishings, and other equipment throughout the area that can afford for fruitful childcare services. Licensee was reminded to replace toys and play equipment which start to degrade or are not in good repair. The footing of the exterior is made up of varying surfaces (natural grass, artificial turf, and concrete pavement). Ample shade is provided by a large tree. The Licensee attested to LPA that children are always supervised when engaged in outside activity. LPA confirmed that the Licensee does not have any bodies of water on site. LPA observed two plastic storage units in the front yard that contain various equipment and supplies for children in care. Licensee informed LPA that the Licensee owns two dogs (one small dog and one large dog), each of whom are vaccinated. The Licensee attested that the dogs have infrequent interactions with children in care.



LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents. The Licensee's records were also viewed. The Licensee’s CPR/First Aid Training (EMSA approved), expiring on 2/4/25, is current and complete as are other relevant licensing documents and forms. Licensee was reminded to renew certifications and training prior to expirations. The Licensee informed LPA that there are no firearms and ammunition present within the FCCH.

The Licensee does not currently provide Incidental Medical Services (IMS) or administer medication to children in care. IMS policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep(CONT. 809-C, Page 3)

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew SapienTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KOWALEWSKI FAMILY CHILD CARE
FACILITY NUMBER: 426208408
VISIT DATE: 10/31/2024
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as an additional resource. Through verbal attestation by the Licensee and by record review, the LPA confirmed Licensee checks and documents napping infants every fifteen minutes as required by the Department.

LPA also informed Licensee of the importance of checking for recalled infant devices on the United States
Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed a RSO profile in FAS on 10/31/24.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensee, Shelly Kowalewski.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Matthew SapienTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC809 (FAS) - (06/04)
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