<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211729
Report Date: 06/06/2023
Date Signed: 06/06/2023 04:59:47 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/06/2023 04:59 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:ISLA VISTA CHILDREN'S CENTERFACILITY NUMBER:
426211729
ADMINISTRATOR:SERINEH VARTANIFACILITY TYPE:
850
ADDRESS:701 H WEST CAMPUS POINTE LN.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:30CENSUS: 10DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:26 PM
MET WITH:Serineh VartaniTIME COMPLETED:
05:17 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 6th, 2023, at 4:26PM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with Director Serineh Vartani and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. The center facility Monday through Friday 8:00AM-5:00PM, including summer season. At the time of the inspection there were ten (10) children and three (3) staff present. This is a combined facility with an infant program.

LPA observed required licensing documents mounted on the wall at the entrance of the facility. Facility uses CareConnect App for the purposes of signing in and out. LPA observed roster to be current. The facility is currently utilizing one (1) classroom for care and supervision. Classroom has ample ventilation, age-appropriate toys, and furniture readily accessible for children in care. LPA observed a variety of daily activities to meet the needs of children including rest and play. Children nap on cots and their individual bedding is stored separately. Children bring their own water bottles and facility also provides filter water for use. LPA observed all cleaning compounds, disinfectants, sharps, combustibles, and tools to be elevated and inaccessible to children. LPA observed the facility has sufficient number of restrooms and sinks available for the children, which were functioning and clean at the time of the inspection. Facility provides morning breakfast, lunch, and snack for children and LPA observed kitchen to be clean, free of rodents, and appliances in working order. Fire extinguisher was last serviced on 1/18/2023. Last emergency drill was conducted on 12/12/2022. LPA advised director emergency drills are to be conducted and documented every six months. Per director, no firearms or ammunition are present on property.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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


Document Has Been Signed on 06/06/2023 04:59 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426211729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
101217(a)(6)

1
2
3
4
5
6
7
Documentation of the educational background, training and/or experience specified in this chapter
1
2
3
4
5
6
7
Director to submit exemption for staff member to LPA via email: maryrose.breault@dss.ca.gov by 6/30/2023.
8
9
10
11
12
13
14
This evidence is met by: Record review and director statement that one (1) staff member does not have required qualifications for a staff aide.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426211729
VISIT DATE: 06/06/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed the outdoor area play area to have ample amount of space for children to play with appropriate toys and equipment. LPA observed ample shade, soft padding, and sandbox free of debris. No bodies of water are present.

Incidental Medical Services are currently not being provided at this time.

LPA reviewed a sampling of children and staff records. Children’s records were observed to be complete and current. Staff files were observed to be current. LPA reviewed SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Teachers have Pediatric First Aid/CPR certificate which expires 3/18/2025 and AB 1207 Mandated Reporter Training certificates expires 2/16/2025.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation interpretations and procedures for Child Care Centers sections 101173 and 101226. When any IMS is provided, an updated plan of operation that includes IMS must be submitted to the Department. the follow 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

Type B deficiency has been cited based on staff files.


Exit interview conducted, report reviewed, and copy provided to director with Appeal Rights.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3