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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214035
Report Date: 06/17/2021
Date Signed: 06/17/2021 03:12:46 PM

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:SHINING STARS PRESCHOOL & INFANT CENTERFACILITY NUMBER:
566214035
ADMINISTRATOR:MEGHAN SHERMANFACILITY TYPE:
840
ADDRESS:2480C E. LAS POSAS RD.TELEPHONE:
(805) 987-2132
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:24CENSUS: 12DATE:
06/17/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Dominique Ruiz-Infant/Toddler Teacher
Michelle C. Wilcox-Director		TIME COMPLETED:
01:15 PM
NARRATIVE
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On June 17, 2021 at 12:20 AM Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to conduct a Case Management-Deficiencies inspection. LPA toured facility with Infant Teacher.

On June 3, 2021, LPA conducted a required annual inspection. LPA issued an LIC 9102 Advisory Notes-Technical Violation. The advisory note for 101238.3(b) Indoor Activity Space. "The floors of all rooms shall have a surface that is safe and clean was not completed." The cabinets and carpet are still severely soiled and a health hazard to children in care especially with COVID-19 guidelines on disinfecting/cleaning surfaces. LPA issued a type A violation for 101238.3(b) Indoor Activity Space.

LPA discussed the limited supply of toys and equipment for the children to work with. Children need materials to work especially with summer vacation coming up. They will be at the center all day with few options available to them.

Today, a deficiency is being cited based on LPA observations in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and a plan of correction was reviewed and developed with Center Director. A copy of this report and appeal rights were discussed and left with Center Director, Michelle C. Wilcox, whose signature on this form confirm receipt of these documents.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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: SHINING STARS PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 566214035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2021
Section Cited

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238.3 Indoor Activity Space
(b) The floors and all rooms shall have a surface that is safe and clean.
This requirement was not met as evidenced by: LPA observed cabinets and carpet to be soiled and in need of cleaning.
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 This poses an immediate health, safety, or personal rights risk to persons in care.
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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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2021
LIC809 (FAS) - (06/04)
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