566207653-7-5-2022-17-CC-ARIS-CG2RGN-20220705130103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566207653
Report Date: 07/05/2022
Date Signed: 07/05/2022 01:01:09 PM

Document Has Been Signed on 07/05/2022 01:01 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:	566207653
ADMINISTRATOR:	JESSICA DERBY		FACILITY TYPE:	830
ADDRESS:	259 WEST SANTA CLARA # 280		TELEPHONE:	(805) 507-8335
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	48	CENSUS: 5	DATE:	07/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:21 AM
MET WITH:	Jessica Derby		TIME COMPLETED:	01:13 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 5, 2022 at 11:21 am, Licensing Program Analyst (LPA) Austin Rios and (LPA) Rona Chavez conducted a Required Annual inspection. LPA met with Director Jessica Derby and advised her the purpose of the inspection. LPA conducted Covid-19 screening questions prior to entering the facility. LPA conducted a tour of the facility inside and out. There were 5 children in care at the time of the inspection with six staff. The center operates from 7:30 AM to 5:30 PM, Monday thru Friday with every other Friday off. Center uses written sign in sheet and is currently using two classrooms for the infant program. The restrooms were found clean and free of toxins. There is a functioning carbon monoxide detector that meets statutory requirement. All required State forms were posted. The outdoor play area is completely fenced and LPA observed age appropriate toys, equipment and shade. Drinking water is available inside and outside. Teacher files reviewed and were found complete with State required forms. Teacher's Medical Health Records verified. Teachers are current with CPR and First Aid which expires in 2023. Children's files reviewed and found complete. Center staff completed Mandated Reporter Training on file. There was a diaper changing table within an arm's reach to the sink. Each child had their infant needs and services plan as well as their own individual feeding plan. The refrigerator had each child's formula, sipping cups, bottles lined up in their own tray and the older infants use mats for nap time. Facility has sufficient amount of cribs and LPA observed no 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 Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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: 566207653
	VISIT DATE: 07/05/2022

NARRATIVE

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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

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: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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