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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213298
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:48:18 PM


Document Has Been Signed on 01/11/2023 02:48 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:LEARNING TREE, THEFACILITY NUMBER:
426213298
ADMINISTRATOR:CHERYLIN LEWFACILITY TYPE:
850
ADDRESS:401 N. FAIRVIEW AVE.TELEPHONE:
(805) 681-1200
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:72CENSUS: 22DATE:
01/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Kim Bruzzese & Abby VasquezTIME COMPLETED:
03:15 PM
NARRATIVE
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On January 11th, 2023, at 10:35AM, Licensing Program Analysts (LPA) Rosie Breault and Giovani Gonzalez conducted an unannounced Annual/Random inspection. LPAs met with facility director Kim Bruzzese Abby Vasquez and advised the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. The center operates from Monday – Friday 8:30AM to 12:15PM. There were twenty two (22) children in care at the time of the inspection, and two (2) teachers.

LPAs observed required licensing documents mounted on the wall and in a prominent location, with food menu. Facility uses written sheets for sign in and out purposes. The facility is currently utilizing two (2) classrooms for care and supervision. Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care and offers ample ventilation. LPAs observed first aid kits available for use in classrooms. Toxins, poisons, cleaning compounds, sharps, and other hazards are in a locked cabinet and inaccessible to children. Both classrooms have sinks for handwashing and offer filtered water. LPAs observed the facility to have sufficient number of toilets, urinals, and sinks available for the children, which are functioning and clean. Center provides brunch and LPAs observed kitchen to be clean, free of pests, and appliances are functioning properly.

The outdoor area has an ample amount of space for children to play with appropriate toys, ample shade, handwashing sinks, filter water stations, and perimeter fencing. No bodies of water are present. Last fire/disaster drill was conducted on 12/15/2022 at 10:00AM

Incident Medical Services are currently not being provided.

CONTINUED LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
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 5


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: LEARNING TREE, THE
FACILITY NUMBER: 426213298
VISIT DATE: 01/11/2023
NARRATIVE
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A sampling of children and staff records were reviewed. LPAs observed children's files to be incomplete. LPA observed staff file to be incomplete. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teacher meets the required qualifications. Teacher present has current Pediatric CPR/First-Aid certificate that are valid until 11/2023.

C2, C3, C4, C5 do not have TB requirements present in file. All children's immunizations are cleared and accurate. This is a violation of Title 22 Division 12 101220.1 (b) (1) and a Type B citation will be issued.

S2 has not been fingerprint cleared which is a violation of Title 22 Division 12 101170 (e) and a Type A citation will be issued. LPAs advised Director S2 needed to vacate campus, however school had closed while reviewing documents.

S2 personnel file was incomplete, and documents were not available at the request of the Department. This is a violation of Title 22 Division 12 and a Type B citation will be issued.

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

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

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: LEARNING TREE, THE
FACILITY NUMBER: 426213298
VISIT DATE: 01/11/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies are listed on LIC809D

Exit interview conducted and report was reviewed with the Director, copy of report, appeal rights, and LIC9224 provided.

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: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/11/2023 02:48 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: LEARNING TREE, THE
FACILITY NUMBER: 426213298

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)

All individuals are subject to a criminal record review....prior to working.

This requirement is not met as evidenced by:
S2 has not been fingerprint cleared per Guardian.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one count which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2023
Plan of Correction
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Director shall have S2 fingerprint cleared by 1/24/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 01/11/2023 02:48 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: LEARNING TREE, THE
FACILITY NUMBER: 426213298

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(b)(1)

The required immunizations for admission to and attendance at a public school....

This requirement is not met as evidenced by:

C2, C3, C4, C5 did not have required immunization or TB test.
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in four out of five persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2023
Plan of Correction
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Director shall submit proof of immunizations and TB test to LPA Maryrose Breault at maryrose.breault@dss.ca.gov no later than 1/24/2023.
Type B
Section Cited
CCR
101217(a)
All personnel records shall be available to the Department to inspect....during normal business hours.

This requirement is not met as evidenced by:
S2 personnel file was incomplete.
Deficient Practice Statement
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Based on review, the licensee did not comply with the section cited above in one count out of two persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2023
Plan of Correction
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Director to provide LPA Maryrose Breault copies of required documents for personnel file which can be found at Title 22 Division 12 101217 by 1/24/2023.
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: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5