426215280-5-3-2022-17-CC-DTHN-CE42BJ-20220503171512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215280
Report Date: 05/03/2022
Date Signed: 05/03/2022 05:15:16 PM

Document Has Been Signed on 05/03/2022 05:15 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 PLACE		FACILITY NUMBER:	426215280
ADMINISTRATOR:	LAUDERDALE, ROBERT		FACILITY TYPE:	840
ADDRESS:	434 NOGAL DR #2		TELEPHONE:	(805) 588-7602
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93110
CAPACITY:	30	CENSUS:	DATE:	05/03/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Robert Lauderdale		TIME COMPLETED:	05:30 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 May 3, 2022 at 4:30 PM, Licensing Program Analyst (LPA) Dean Thompson and Susana Martinez conducted an announced Case Management inspection. Prior to entering the facility, LPA spoke to licensee Robert Lauderdale and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Licensee and LPA toured the facility inside and outside. There were 12 children in care at the time of the inspection. The purpose of today's inspection is to evaluate the center for a change of classroom from room#2 to room#5 and an increase of capacity. Licensee has requested an increase of capacity from 30 to 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. LPA observed required licensing documents on the walls. LPA inspected the classroom #5 inside and the outside playground . 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 (girls 4 toilets and 3 sinks and boys 3 toilets/2 urinals and 3 sinks) which exceeds the requirement for 40 children. . LPA Thompson got a verbal from the Santa Barbara Fire Department stating the fire clearance conducted on 4/10/2023 was documented in error. Santa Barbara Fire Department confirm they will conduct a new fire clearance on 5/4/2022 and submit new documentation showing fire clearance from room #5. Continued on LIC 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

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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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: 05/03/2022

NARRATIVE

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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.

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

LPA Thompson received documents from the Hope Elementary School District Superintendent.
The capacity of 40 for room #5 meets requirements from Health & Safety code section 1596.806.

Entrance Checklist was provided to the applicant.

Effective date of license is today, May 3,2022.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Robert Lauderdale

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

LIC809 (FAS) - (06/04)

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