406200031-5-7-2024-17-CC-EBAY-D52TXU-20240507150744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406200031
Report Date: 05/07/2024
Date Signed: 05/07/2024 03:08:50 PM

Document Has Been Signed on 05/07/2024 03:08 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:	GRANDMOTHER'S HOUSE AT ST. STEPHENS		FACILITY NUMBER:	406200031
ADMINISTRATOR/ DIRECTOR:	DOTTIE RYAN		FACILITY TYPE:	850
ADDRESS:	1344 NIPOMO STREET		TELEPHONE:	(805) 541-1305
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS:	DATE:	05/07/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Dottie Ryan		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

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On 5/7/241, at 12:30 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random Inspection the abovementioned Child Care Center (CCC). LPA met with Dottie Ryan, Director of the CCC and explained the purpose of the inspection. The LPA, in the company of Director, toured the interior and exterior of the CCC.

The CCC operates from 8:15 AM to 3:00 PM- Monday, 8:00 AM - 3:00 Tuesday -Thursday and 8:00 AM to 12:45 PM Friday. The CCC uses three classrooms (Classroom 1- Toddlers; Classroom 2- four year old children and Classroom 3- three year old children) for child care. LPA observed 23 children on site during the inspection along with three teachers (associated and cleared). LPA notes the Director assist with the care and supervision of children at the CCC.

LPA reviewed licensing required notices and documents posted predominately in each classroom of the CCC. CCCs constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Child in care have access to filtered water provided by the CCC both inside and outside the facility. The CCC utilizes an electronic Sign In/Out system. LPA reviewed a sampling of children from the system which contains both arrival and departure times as well as the electronic signature of parents of children in care.

The classrooms of the CCC are clean and organized. The classrooms have age appropriate toys and furnishings available for children as well as appropriate ventilation. CCC has an operable carbon monoxide detector on site The aforementioned was not tested as children in care were napping during the inspection period. The restroom in the CCC is in safe and sanitary operating condition. Disinfectants and cleaning solutions are secured on elevated cabinet shelves in each classroom which are inaccessible to children in

(CONT. 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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: GRANDMOTHER'S HOUSE AT ST. STEPHENS	FACILITY NUMBER: 406200031
	VISIT DATE: 05/07/2024

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care. Additionally, medication in the CCC is stored in a "medication box" which is locked and store on the shelf of a elevated cabinet in Classroom 2. LPA observed sharps in the CCC on elevated shelves in each classroom which are beyond the reach of children in care.

The CCC's outdoor playground areas are enclosed by fencing. The footing in the areas are varied. The area also has a large sand box and well as a play structure with wood chips at the base. The fence gates of the playground areas are observed secure. The toys and play equipment are in suitable condition and free of sharp, loose or pointed objects. The play structure in the playground area has adequate cushioning materials to absorb falls and an abundance of shade is observed in the courtyard area where children also engage in outdoor activities. No bodies of water were observed on site. Waste receptacles with tight fitting covers were observed throughout the CCC.

LPA reviewed staff and children records. The children’s records are complete and found to contain emergency contact information as well as immunization records, among other required licensing documents. Staff records are reviewed and contained current Pediatric CPR/First Aid and Mandated Reporter certifications. Director informed LPA no firearm or ammunition is stored on site.

This facility 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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions
(CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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: GRANDMOTHER'S HOUSE AT ST. STEPHENS	FACILITY NUMBER: 406200031
	VISIT DATE: 05/07/2024

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regarding the process or CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Dottie Ryan.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC809 (FAS) - (06/04)

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