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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208408
Report Date: 02/06/2025
Date Signed: 02/06/2025 02:22:04 PM

Document Has Been Signed on 02/06/2025 02:22 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:
02/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Shelly KowalewskiTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
NARRATIVE
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On February 6, 2025 at 1:00 PM Licensing Program Analyst (LPA) Elizabeth George conducted an unannounced inspection to conduct a case management - deficiencies report. LPA met with licensee, Shelly Kowalewski, and discussed the purpose of the inspection. LPA along with licensee toured the interior and exterior of the facility. There were 6 children in care of 2 staff at time of inspection.

During the tour LPA observed cabinets containing cleaning compound's and toxins to be accessible to children in care. One cabinet in the laundry room, which is accessible to children, has defective child proof locks located on the inside of cabinets. The adjacent bathroom, which is utilized by children in care, cabinet under the sink had the same defective child proof lock. When gently pulled the lock did not catch and the door was easily opened. LPA advised licensee this needs to be inaccessible to children at all times. Licensee stated the locks would be replaced this evening. During the inspection licensee removed the cleaning compounds and toxins from cabinets in both the laundry room and bathroom and placed into the locked office which is inaccessible to children in care.

At the time of the inspection licensee was unable to produce the LIC9040 Facility Roster. Licensee created a current Facility Roster during the inspection.

During today's visit one Type B deficiency is being cited under CCR, Title 22 Division 12.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted, appeals rights were given and report was reviewed with Licensee Shelly Kowalewski.
Ana TolentinoTELEPHONE: (805) 562-0437
Elizabeth GeorgeTELEPHONE: (805) 680-7175
DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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Document Has Been Signed on 02/06/2025 02:22 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
CCR
102417(g)(4)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(4)Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored
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Licensee to make the cabinets containing the cleaning compunds and toxins completly inaccessible to children in care.
During the inspectin the cleaning compounds and toxins were removed from the accessible areas.
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 This requirment is not met as evidenced by:
Based on LPAs observations, the cleaning compounds and toxins in the laundry roon and bathroom were accessible to children in care. This poses a potential risk to health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana TolentinoTELEPHONE: (805) 562-0437
Elizabeth GeorgeTELEPHONE: (805) 680-7175

DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2025

LIC809 (FAS) - (06/04)
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