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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709863
Report Date: 07/14/2022
Date Signed: 07/14/2022 02:58:36 PM


Document Has Been Signed on 07/14/2022 02:58 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:COMMUNITY PRESBYTERIAN CHURCH PRE SCHOOLFACILITY NUMBER:
561709863
ADMINISTRATOR:BORDEAUX, LYNNFACILITY TYPE:
830
ADDRESS:1555 POLI STREETTELEPHONE:
(805) 648-6555
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:14CENSUS: 3DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Lynn BoredeauxTIME COMPLETED:
03:13 PM
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On July 14, 2022 at 12:47 PM, Licensing Program Analyst (LPA) Austin Rios conducted a Required Annual inspection. LPA met with director Lynn Bordeaux and explained the purpose of the inspection. LPA asked Covid-19 screening questions prior to entering the facility. LPA conducted a tour of the facility inside and out. There were 3 children in care at the time of the inspection and two staff. The center operates from 7:30 AM to 4:30 PM and is open Monday thru Friday.

Licensing required notices were posted prominently on the wall at the entrance of the facility. The facility uses one classroom for the infants and has another class for toddlers. Bathrooms were observed to be clean and free of toxins. Children bring their own water. .The playground has age appropriate toys/equipment. LPA did not observe any toxins/hazardous items accessible to children. The classroom has age appropriate toys and furniture available for children. There is a functioning carbon monoxide detector that meets statutory requirement. Children bring their own lunch. Updated disaster drill was on file. Center uses written sign in sheet.

There was a diaper changing table within an arm's reach from the sink. Each child had their infant needs and services plan as well as their own individual feeding plan. Each infant has there own crib with no blankets inside any crib or any objects hanging above. Facility is doing 15 minute check for all infants and the cribs are not blocking the entrance or exit.


Cont on 809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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: COMMUNITY PRESBYTERIAN CHURCH PRE SCHOOL
FACILITY NUMBER: 561709863
VISIT DATE: 07/14/2022
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 A sampling of children and staff records were reviewed and found current. At least one staff present has current Pediatric First Aid/CPR certificates that expire on 3/1/2024. Updated mandated reporter training certificates were on file.

Licensee was reminded that all adults 18 and over, 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 licensee 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 licensee 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

Incidental Medical Services (IMS) 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 IMA 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

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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: COMMUNITY PRESBYTERIAN CHURCH PRE SCHOOL
FACILITY NUMBER: 561709863
VISIT DATE: 07/14/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lynn Bordeaux.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3