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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215998
Report Date: 04/16/2021
Date Signed: 04/16/2021 01:02:49 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:SMBSD - LIBBON PREKINDERGARTENFACILITY NUMBER:
426215998
ADMINISTRATOR:COLLEN LATHERYFACILITY TYPE:
850
ADDRESS:750 MEEHAN ST. ROOM C-3TELEPHONE:
(805) 928-1783
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:30CENSUS: 0DATE:
04/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Raquel ValdezTIME COMPLETED:
11:00 AM
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On 4/16/2021, at 9:32 AM, Licensing Program Analyst (LPA) Gigi Reyes made an announced Pre licensing Inspection. LPA met with Raquel Valdez, Preschool Program Director and explained the purpose of the inspection. There are no children present at the time of the inspection. Due to COVID 19 and the California Department of Public Health guidelines for social distancing, this inspection was conducted with Director via the Face Time application. LPA asked the Director Pre screening Tele-Inspection questions prior to the inspection. All responses provided by the Director suggest no COVID exposures on site.

SMBSD - Libbon Center submitted an application for Pre School Child Care Center with a capacity of 24. The Center will be operating in 2 sessions, morning, 8:00 AM to 11:00 AM, and afternoon, 11:40 AM to 2:40 PM sessions. Center is located at Bill Libbon Elementary School in Santa Maria CA. The Center was toured inside and out. Room C3 will be used by pre school children. Center has 3 sinks and 2 toilets. Indoor and Outdoor area measurements are on file. LPA observed Child Care Center is clean, safe, sanitary and newly constructed. Center is set up with age appropriate tables and chairs and toys. Drinking water fountain is readily available inside and outside. Children will also be provided with refillable water bottle. The pre packed snack, lunch will be provided by the school district food service department. Sign in Sign out will be performed electronically.

Continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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: SMBSD - LIBBON PREKINDERGARTEN
FACILITY NUMBER: 426215998
VISIT DATE: 04/16/2021
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Outside play area is appropriately fenced, there is a rubber mat cushioning underneath and around the play equipment. Surface is safe, clean and free of potential hazard.
Outdoor space has shaded rest area. LPA did not observe any bodies of water. LPA observed the presence of carbon monoxide and smoke detectors. Director informed LPA no firearms or ammunition are stored on site.

LPA discussed with Director the Licensing forms to be posted, License, Emergency Disaster Plan (LIC 610), Parent's Rights Poster (PUB) 393, Personal Rights (LIC613A), Child Car Seat Law, Menu.

Director has current CPR/First Aid which expires on 8/10/21, Child Development Program Director Permit was presented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

During the course of the inspection, LPA discussed COVID-19 Mitigation plan, best practices, and the implementation of such in the Center.


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SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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: SMBSD - LIBBON PREKINDERGARTEN
FACILITY NUMBER: 426215998
VISIT DATE: 04/16/2021
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The facility was inspected by Santa Maria Fire Department and a fire clearance for capacity of 24 was granted on 4/16/2021.

Issuance of License is pending subject to further review.

An exit interview was conducted with Director and copy of this report was provided to Director via email with a read receipt or confirmation of receipt which will act as the Director's signature.



LPA provided Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC809 (FAS) - (06/04)
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