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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216163
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:13:36 PM


Document Has Been Signed on 03/10/2022 12:13 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:COMMUNIFY LITTLE VILLAGE INFANT CENTERFACILITY NUMBER:
426216163
ADMINISTRATOR:LORRAINE NEENANFACILITY TYPE:
830
ADDRESS:219 W. CHAPELTELEPHONE:
(805) 922-2243
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:4CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kim EichertTIME COMPLETED:
12:20 PM
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On 3/10/22, at 10:00 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Prelicensing Inspection of the abovementioned Child Care Center (CCC) and met with Program Manager, Kim Eichert. LPA informed Program Manager of the nature and purpose of the inspection. LPA notes there are no children on site at the time of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Child Care Center (CCC) from 7:00 AM to 5:15 PM, Monday- Friday. The Applicant also Informed LPA of the intention to provide care for children from three (3) months of age to eighteen (18) months of age.

LPA toured the interior and exterior of the CCC with the Program Manager. This CCC has a Preschool license with toddler component located in the same location as this program 426213957. The interior of the CCC has an activity area, separate napping room and restroom where the changing table will be located. LPA observed the activity room to be equipped with age appropriate furnishing and toys for infants. The napping room is equipped with cribs and cots that are age appropriate for infants. LPA observed individual cubbies near the entry of the facility which will be used for infants to store their personal items. The CCC also has a kitchen on site. The kitchen contains an operable refrigerator to store the food at the CCC. Program Manager confirmed that breast milk brought by individual families will be labeled and stored in the refrigerator. The CCC will provided formula and food to older infants in the program. LPA observed the changing table is located in the CCC restroom and is close to a working sink. The CCC has one (1) sink and one (1) toilet accessible for child care services. The exterior CCC has a small front patio that is completely fenced and will be used for outdoor play. The front patio consists of grassy and cemented area. Shade is provided by means of umbrellas. Program Manager stated that water pitchers will be used to ensure that children have access to drinking water at all times. LPA observed no bodies of water on site.

LPA observed a combination carbon monoxide detector and smoke detector installed in the ceiling of the activity room. Detector was tested at 10:44 AM, and was working appropriately. LPA observed a required fire extinguisher 2A10BC. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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: COMMUNIFY LITTLE VILLAGE INFANT CENTER
FACILITY NUMBER: 426216163
VISIT DATE: 03/10/2022
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LPA reviewed organizational, financial and administrative documentation. All documents are current, complete and in order. A fire inspection was completed at the CCC's by Santa Maria Fire Department on 08/19/21. Clearance was grant the same day. Program Manager stated there are no firearms or ammunition on site.

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

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.

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. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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: COMMUNIFY LITTLE VILLAGE INFANT CENTER
FACILITY NUMBER: 426216163
VISIT DATE: 03/10/2022
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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.

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 facility representative, Kim Eichert.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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