426215638-8-31-2021-17-CC-SMCA-C6EVFW-20210831162437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215638
Report Date: 08/31/2021
Date Signed: 08/31/2021 04:24:46 PM

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:	PROVIDENCE PRESCHOOL		FACILITY NUMBER:	426215638
ADMINISTRATOR:	TRACY LARSON		FACILITY TYPE:	850
ADDRESS:	3225 CALLE PINON		TELEPHONE:	(805) 962-3091
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	72	CENSUS: 13	DATE:	08/31/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Tracy Larson		TIME COMPLETED:	04:30 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 August 31, 2021, at 1:54 PM a Required 1 Year Inspection was conducted by LPA S. Mendoza-Ceja who met with Interim Tracy Larson. Prior to entry into the center, a risk assessment was conducted for COVID-19. The preschool operates Monday – Friday, 8:15 AM - 3:00 PM. The center was toured inside and outside. The classrooms were observed to be clean and orderly. The appropriate documents were posted for review. There is carbon monoxide detector in each of the classrooms. The restrooms were observed to clean. The outside playground equipment was observed to be well maintained and age appropriate. A review was conducted of children's records for Emergency Information and Medical Assessments. Review of medications revealed the center accepted an Epi Pen in a plastic bag with child #1's name and no prescription on file. Staff records were reviewed for qualifications, AB1207 Child Abuse Mandated Reporter Training, Physical/required vaccinations. LPA reviewed current CPR and First Aid for one staff which expires 05/27/2023. LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA reviewed verification of immunization for staff. 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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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

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: PROVIDENCE PRESCHOOL	FACILITY NUMBER: 426215638
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/31/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/01/2021 Section Cited	1 2 3 4 5 6 7	Health Related Services: Health Related Services: In centers where the licensee chooses to handle medications: Each container shall have an unaltered label. All Prescription medications may be administered if all of the following conditions are met: Prescription medications shall be administered in accordance with the label directions
	8 9 10 11 12 13 14	as prescribed by the child's physician. This documentation shall be kept in the child's record. This violaltion was evidenced by observation, interview and review of medication and child #1's file which revealed medication was accepted in plastic bag with child's name and no prescription on file. This poses an immediate risk to children in care.	8 9 10 11 12 13 14
	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 Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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: PROVIDENCE PRESCHOOL	FACILITY NUMBER: 426215638
	VISIT DATE: 08/31/2021

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

Deficiency is cited based on interview, review of records and medication maintained in the facility in accordance with the California Code of Regulations, Title 22, refer to LIC809D.

Licensee Shall provide parents with a copy of the The Type A violations and obtain the parent's signature on the LIC9227. An exit interview was conducted, and Plan of Correction was reviewed and developed with the Director Tracy Larson. Appeal Rights were reviewed.

LPA observed the "Notice of Site Visit" posted.

Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3