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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208408
Report Date: 03/04/2025
Date Signed: 03/04/2025 03:59:03 PM

Document Has Been Signed on 03/04/2025 03:59 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: 12DATE:
03/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Shelly KowalewskiTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On March 4, 2025 at 12:25 PM Licensing Program Analysts (LPAs) Elizabeth George and Giovani Gonzalez conducted an unannounced case management inspection. LPAs met with licensee, Shelly Kowalewski, and discussed the purpose of the inspection. LPAs along with licensee toured the interior and exterior of the facility.

Upon arrival there were 8 children in the care of the assistant. LPAs asked assistant if any of the children were school age or at least six years old. Assistant informed LPAs only 1 child was school age. LPAs informed licensee in order for 8 children present without an additional assistant, 1 child would need to be enrolled in school and 1 child 6 years old. LPAs reviewed the ages of the children and found 7 children to be between the ages of 2-5 and only one child to be enrolled in school. At this time, licensee was out of ratio. As a result one type B deficiency is being issued.

LPAs asked assistant if they had current CPR/ First Aid. Assistant stated that she does not. As a result one Type B deficiency is being issued. A previous licensing report was issued on 2/6/25 giving notice of the same violation. A Civil Penalty has been assessed for repeating the same violation within 12 months.

During today's visit two Type B deficiencies are being cited under CCR, Title 22 Division 12 and Health and Safety code on the attached 809-D.

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.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Elizabeth George
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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 03/04/2025 03:59 PM - It Cannot Be Edited


Created By: Elizabeth George On 03/04/2025 at 03:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KOWALEWSKI FAMILY CHILD CARE
FACILITY NUMBER: 426208408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2025
Section Cited
HSC
1596.866(b)

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(b) Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR...shall be onsite at all times when children are present at the facility...
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Licensee to have ALL assistants in the home that are left alone with children in care to obtain the necessary training required.
The certifications are to be emailed to LPA @ elizabeth.george@dss.ca.gov no later than March 14, 2025.
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This requirement is not met as evidenced by:
LPAs observation, record review and interview with licensee and assistant, the assistant left alone with children while licensee was out does have current CPR/ 1st Aid training. This poses a potential risk to health and safety of children in care.
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Type B
03/14/2025
Section Cited
CCR102416.5(b)(3)

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(3)More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
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Licensee to review Title 22 regulations and submit a written statement to LPA by email @ elizabeth.george@dss.ca.gov no later than March 14, 2025.
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LPAs observed assistant with 8 children only one of whom was school age, seven other children aged 2-5 years old.
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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.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Elizabeth George
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


LIC809 (FAS) - (06/04)
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