566207651-6-30-2022-17-CC-ARIS-CFVSM8-20220630135931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566207651
Report Date: 06/30/2022
Date Signed: 06/30/2022 01:59:41 PM

Document Has Been Signed on 06/30/2022 01:59 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:	GREAT PACIFIC CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	566207651
ADMINISTRATOR:	JESSICA DERBY		FACILITY TYPE:	850
ADDRESS:	259 WEST SANTA CLARA STREET		TELEPHONE:	(805) 507-8335
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	105	CENSUS: 25	DATE:	06/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Jessica Derby		TIME COMPLETED:	02:13 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 July 30, 2022 at 9:18 AM, Licensing Program Analyst (LPA) Austin Rios and CDSS employee Karen Chang conducted a Required Annual inspection. LPA met with director Jessica Derby 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 twenty five children in care at the time of the inspection and ten staff. The center operates from 7:30 AM to 5:30 PM and is open Monday thru Friday. All documents to be posted were posted prominently at the entrance of the facility. In each classroom, there was a first aide kit and emergency disaster plan as well as the snack menu posted. The facility uses .... classrooms. Bathrooms were observed to be clean and free of toxins. There is water inside and outside for the children to have access too. The outdoor playground is completely enclosed by a fence. The playground has an ample amount of shade available and 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. The daily schedule was posted in each classroom. All trash cans have tight fitting lids. There is a functioning carbon monoxide detector in all classrooms that meets statutory requirement. The center provides snacks but children bring their own lunch. Center uses written sign in sheet that was reviewed by LPA. Cont. on 809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

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: GREAT PACIFIC CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 566207651
	VISIT DATE: 06/30/2022

NARRATIVE

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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 expires in 2023. Teachers present have current AB 1207 Mandated Reporter Training certificate 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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.

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 Jessica Derby.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

LIC809 (FAS) - (06/04)

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