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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211978
Report Date: 06/27/2023
Date Signed: 06/27/2023 02:50:58 PM


Document Has Been Signed on 06/27/2023 02:50 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:CHILDS VILLAGE PRESCHOOL OF LOMPOC, AFACILITY NUMBER:
426211978
ADMINISTRATOR:KIMBERLY KRANZFACILITY TYPE:
850
ADDRESS:126 NORTH G STREETTELEPHONE:
(805) 735-7272
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:45CENSUS: 18DATE:
06/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Selene ServinTIME COMPLETED:
02:45 PM
NARRATIVE
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On 6/27/23, at 11:40 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Inspection of the abovementioned Child Care Center (CCC). LPA met with Site Supervisor Selene Servin, and explained the nature of the inspection. LPA, in the company of the Site Supervisor, toured the interior and exterior of the CCC. LPA notes 18 children are on site during the inspection, along with four teachers (cleared and associated) providing care and supervision. The CCC operates from 7:30 AM-4:30 PM Monday - Friday. The CCC consists of an activity room for the children as well as front and rear outdoor play areas. Two rooms of the CCC are not in use as the rooms previously housed infants which are now off site on a separate license.

LPA observed the room used for child care to be organized and free of toxins. The room is equipped with age appropriate furniture and toys. There is ample storage space in the classroom and storage for children’s personal effects. LPA observed a parent board near the entry which contain required licensing documentation and forms. LPA observed a carbon monoxide detector in the CCC. At 1:05 PM, the carbon monoxide detector was tested and found to be operable. The restroom used by children in care is in sanitary and free of toxins and hazards.

The CCC has one large operable refrigerator in the CCC's kitchen. LPA notes the kitchen is inaccessible to children in care. Site Supervisor informed LPA lunches for children in care are provided by parents, while snacks are provided by the CCC. Site Supervisor informed LPA lunches are checked by CCC staff members to ensure food brought from home contain food items from the essential food groups and healthy choices. The CCC provides bottled water for the children inside the CCC and in the outside play areas. The CCC water sources have been tested for lead containment levels.



The outdoor play areas are completely enclosed by fencing and have varied footing. LPA observed play structures in the outdoor play areas to be age appropriate. LPA reminded Site Supervisor to ensure cushioning material should be under all play structures. LPA observed ample shade in the outdoor play
(CONT. LIC 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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 06/27/2023 02:50 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: CHILDS VILLAGE PRESCHOOL OF LOMPOC, A
FACILITY NUMBER: 426211978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above in as LPA observed bowed plastic composite slates at the base of the tree which serves as a tripping hazard fron children in care and children in care are able to place their limbs in the opening between the slates. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2023
Plan of Correction
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Licensee to repair, replace or remove plastic complosite bowed slates at the base of the tree and provide photographic proof of the correction to CCLD (elvin.baddley@dss.ca.gov) no later than 7/11/23.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the LIcensee did not comply with the section cited above as S1, S2, S3, and S4's Mandated Reporter cerification expired and is not current, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2023
Plan of Correction
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Licensee to provide proof of complete Mandated Reporter Training for S1, S2, S#, and S$ and submit certification of completion to CCLD (elvin.baddley@dss.ca.gov) no later than 7/11/23.
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: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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: CHILDS VILLAGE PRESCHOOL OF LOMPOC, A
FACILITY NUMBER: 426211978
VISIT DATE: 06/27/2023
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 areas which is provided by trees and building over hangs. LPA observed a a secure garage storage in the rear of the CCC and a secure shed in the front of the property. Each contains CCC supplies and equipment. At 12:35 PM, LPA observed bowed plastic composite slates at the base of a tree in the rear outdoor play area which posed a hazard. The bowed composite slate created an opening large enough for a child in care to trip over and/or places their limbs inside. LPA informed Site Supervisor to replace toys, play equipment and fixtures which degrade or are not in good repair. LPA observed no bodies of water on site.

LPA reviewed the sign in and out forms of the CCC which contains the arrival and departure times of children as well as electronic signatures of authorized representatives.

A sampling of staff and children's records were reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff records were reviewed. All staff members were current with Pediatric First Aid/CPR (EMSA Approved). At 1:40 PM LPA reviewed staff documentation and notes S1, S2, S3, and S4 do not have current Mandated Reporter Training certifications, Site Supervisor was reminded all staff members' Mandated Reporter Training certifications must be renewed every two years and must be current.

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 PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters/.



Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

(CONT. 809-C, Page 3)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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: CHILDS VILLAGE PRESCHOOL OF LOMPOC, A
FACILITY NUMBER: 426211978
VISIT DATE: 06/27/2023
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Type B Deficiencies are being cited based on LPA's observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Site Supervisor was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

Site Supervisor confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Exit interview conducted and report was reviewed with the Facility representative Selene Servin.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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