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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710487
Report Date: 10/13/2021
Date Signed: 10/13/2021 02:34:18 PM

Document Has Been Signed on 10/13/2021 02:34 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:NEW LIFE COMMUNITY CHURCH OF THE NAZARENEFACILITY NUMBER:
401710487
ADMINISTRATOR:COURTNEY CROSSONFACILITY TYPE:
850
ADDRESS:990 JAMES WAYTELEPHONE:
(805) 489-3575
CITY:PISMO BEACHSTATE: CAZIP CODE:
93449
CAPACITY: 78TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
10/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Courtney CrossonTIME COMPLETED:
02:30 PM
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On 10/13/21 at 12:45 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Inspection the abovementioned Child Care Center (CCC). The LPA met with Courtney Crosson, Director of the CCC and explained the purpose of the inspection. The LPA, in the company of the Director, toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 5:30 PM, Monday - Friday. The CCC uses seven classrooms (Classroom 1- ages 2, Classroom 2- ages two and three, Classroom 4- ages three, Classroom 5- ages 3, Classroom 6- ages 3, Classroom 7- Pre Kindergarten and Classroom 8 - Pre Kindergarten) for care. LPA observed 30 children on site along with 9 teachers (cleared and associated) providing supervision.

All classrooms of the CCC were clean and organized. The classrooms had age appropriate toys and furnishings available for children in care. The CCC has an operable carbon monoxide detector which was tested (1:10 PM). The restrooms (2) used from care are detached from the classrooms. Each restroom was observed in safe and sanitary operating condition. LPA observed operable refrigerator in each classroom. The main refrigerator is located in the rear of Classroom 2. Food items in the refrigerator were labeled and dated. LPA notes snacks are provided by the CCC, while children in care bring lunches from their homes. The CCC reminds parent to provide healthy lunches which contain the essential food groups. There is available drinking water for children both inside the classroom and outside in the play area. LPA reviewed posted menu in the classrooms while licensing required notices and documents are posted near the entry of each classroom. Likewise, sign In/out forms which are placed at the entry of the classrooms were reviewed by the LPA and found to be completed appropriately.

Disinfectants and cleaning solutions are observed in elevated locations in each classroom which is beyond the reach of children in care and inaccessible. Likewise, sharps in the classroom are observed on elevated shelves, beyond the reach of children in care. Medication at the CCC is stored in a locked box in Classroom 2 which is inaccessible to children. Waste receptacles with tight fitting covers were observed throughout the

(CONT.809-C)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: NEW LIFE COMMUNITY CHURCH OF THE NAZARENE
FACILITY NUMBER: 401710487
VISIT DATE: 10/13/2021
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CCC.

The CCC has three outdoor playground areas. Each playground is enclosed by iron rod fencing. The fences' entry/exit gates are secured. LPA observed age appropriate toys and play equipment in each of the the play areas. The toys and play equipment observed are in suitable condition and free of sharp, loose or pointed objects. The play structures in the playground areas have adequate cushioning materials to absorb falls and an abundance of shade created by trees and building overhangs. No bodies of water were observed on site, however LPA observed a man made miniature pond which was empty. Director informed LPA the aforementioned is filled on occasions and drained after use. Further, Director stated children are directly supervised when the miniature pond in filled.

A sampling of staff and children's records are reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff member's records were reviewed and contained current CPR and First Aid certifications and well as Mandated Reporter certifications. Director informed LPA no firearm or ammunition is stored on site.

This CCC provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA discussed COVID 19 guidance and best practices with the Director. Director was reminded that it is Director's responsibility to know the regulations for a CCC which can be accessed on-line at www.ccld.ca.gov



In areas evaluated, there were no deficiencies cited at this time.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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