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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215280
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:11:02 PM


Document Has Been Signed on 04/22/2022 04:11 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:MR. ROB'S PLACEFACILITY NUMBER:
426215280
ADMINISTRATOR:LAUDERDALE, ROBERTFACILITY TYPE:
840
ADDRESS:434 NOGAL DR #2TELEPHONE:
(805) 588-7602
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY:30CENSUS: 28DATE:
04/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Andrea LauderdaleTIME COMPLETED:
04:20 PM
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On 04/22/2022 a 2:50PM an inspection was conducted by Licensing Program Analyst (LPA) S. Mendoza-Ceja who met with Andrea Lauderdale. The purpose of today's inspection is to evaluate the center for a change of classrooms to #5 and an increase of capacity. Licensee has requested licensure for 40 school age children. The after school program is located at Vieja Valley Elementary School and will be operating Monday - Friday, 1:30 PM - 5:00PM. Upon arrival, LPA observed classroom #5 being utilized by the after school program.

LPA inspected the classroom #5 inside and the outside playground . The classroom was measured to be 961 square feet indoors. LPA observed the classroom to be clean, orderly, and appropriately furnished for school age children. Drinking water available inside and outside. The restrooms were also inspected the POD C restrooms (girls 4 toilets and 3 sinks and boys 3 toilets/2 urinals and 3 sinks) which exceeds the requirement for 40 children. LPA was excorted to the outdoor playground located on the north east side of the school. LPA also inspected the restrooms located on the large playground area to have a restrooms available (girls 3 toilets and 2 sinks and boys 2 toilets/2 urinals and 2 sinks).

LPA discussed and the appropriate documents to be posted for review which includes and not limited to the Snack Menu, Parent Rights, Personal Rights, Earthquake Preparedness Checklist, Emergency Disaster Plan, Lead Exposure Publication, Car Seat Safety, and SIDS.

LPA discussed Unusual Incidents and provided the email address: CDSS CCL Unusual Incident Reports DO 17 <UnusualIncidentReportsDO17@dss.ca.gov>.



LPA reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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 2


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: MR. ROB'S PLACE
FACILITY NUMBER: 426215280
VISIT DATE: 04/22/2022
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Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following 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



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Increase of Capacity is Pending further review. Exit interview conducted and report was reviewed with the facility representative Andrea Lauderdale.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
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