566208039-6-2-2022-17-CC-ARIS-CEZUC2-20220602152714

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566208039
Report Date: 06/02/2022
Date Signed: 06/02/2022 03:27:26 PM

Document Has Been Signed on 06/02/2022 03:27 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:	ROSE AVENUE STATE PRESCHOOL		FACILITY NUMBER:	566208039
ADMINISTRATOR:	SHANNON COLETTI		FACILITY TYPE:	850
ADDRESS:	220 S. DRISKILL ST. ROOM 1001		TELEPHONE:	(805) 385-1501
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	23	CENSUS: 6	DATE:	06/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Angela Perez		TIME COMPLETED:	03:45 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 June 2, 2022 at 1:10 PM Licensing Program Analyst (LPA) Austin Rios and (LPA) Rona Chavez conducted a Required Annual inspection. LPA met with director Angela Perez 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 6 children in care at the time of the inspection and five staff. Facility is located at classroom number 10 and is located on the school grounds of Rose Avenue Elementary School. It operates from 8:00 AM to 11:00 PM for the morning session and afternoon session is 11:05 AM to 2:05 PM. The center operates Monday to Friday. Licensing required notices were posted prominently on the wall in the classroom. The facility uses one classroom. Bathrooms were observed to be clean and free of toxins. Children bring their own water. 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. There is a functioning carbon monoxide detector that meets statutory requirement. LPA observed and reviewed the posted lunch menu. The center provides breakfast and lunch. A sampling of children and staff records were reviewed and found current. Facility staff for afternoon session does not have a valid Pediatric CPR/First Aid certificate on file. California Code of Regulation, (Title 22 Division 12 and 101216(f) type B deficiency is being cited on the attached LIC 809 D).Teachers present have current AB 1207 Mandated Reporter Training certificates on file. 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: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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: ROSE AVENUE STATE PRESCHOOL	FACILITY NUMBER: 566208039
	VISIT DATE: 06/02/2022

NARRATIVE

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Center uses written sign in sheet.

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 Angela Perez.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/02/2022 03:27 PM - It Cannot Be Edited

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: ROSE AVENUE STATE PRESCHOOL	FACILITY NUMBER: 566208039
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Licensee will attend CPR training and send proof to LPA Austin Rios by 6/30/2022 at (805) 635-4725 or austinrios@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

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