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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 09/09/2024
Date Signed: 09/09/2024 01:39:44 PM

Document Has Been Signed on 09/09/2024 01:39 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 FCC AKA DOWNTOWN BABY SHELL BEACHFACILITY NUMBER:
406214343
ADMINISTRATOR/
DIRECTOR:		ROBIN ROSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 888-9504
CITY:PISMO BEACHSTATE: CAZIP CODE:
93449
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Robin RoseTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 09/09/2024, at 9:30 AM, Licensing Program Analysts (LPA's) Elvin Baddley and Matthew Sapien conducted an Annual Random Inspection of the abovementioned Family Child Care Home (FCCH). LPA's met with Robin Rose, Licensee of the FCCH and explained the purpose of the inspection. LPA's, in the company of the Licensee, toured the interior and exterior of the FCCH. The home’s living room, kitchen, guestrooms, hallway bathroom and back-yard are used for child care, while the home’s master bedroom is excluded. At the time of the inspection LPA's observed four children present.

LPA's observed required licensing forms and documents post on the wall near the entry of the FCCH. LPA's observed a fireplace in the living room which is screened by a child safety gate. A combination smoke/carbon monoxide detector is observed in the FCCH. The detector were tested at 10:36 AM and found to be operable.
LPA's observed a regulation fire extinguisher in the FCCH's kitchen area which was serviced on 02/06/24. LPA's reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA's reviewed the home’s fire/disaster drill log. The most recent fire drill occurred on 07/02/24.

The home was orderly and the bathroom used for care was clean and free of toxins. LPA's observed cleaning compounds on the shelf of an elevated cabinet above the kitchen sink. At this time, there are no medications presently for children, however, household medications are typically kept on an elevated shelf in a neighboring kitchen cabinet which is also inaccessible to children in care. LPA's observed sharps above the oven in the kitchen which is beyond the reach of children in care. Toys, furniture and equipment in the FCCH are age appropriate.

The FCCH's backyard is enclosed by wooden fencing. The backyard fence’s entry/exit gates are secure. Toys and play equipment observed in backyard are age appropriate. LPA's observed cushioning material made up of wood bark underneath the play structure in the backyard area. LPA's reminded the Licensee to replace play equipment when it begins to degrade or is not in good repair. LPA's observed ample shade in the backyard area in the form of trees, home overhangs, and a shade covering. LPA's observed no bodies of water on site. (Cont. 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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 4
Document Has Been Signed on 09/09/2024 01:39 PM - It Cannot Be Edited


Created By: Elvin Baddley On 09/09/2024 at 12:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ROSE FCC AKA DOWNTOWN BABY SHELL BEACH
FACILITY NUMBER: 406214343

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview/record review, the licensee did not comply with the section cited above in that Licensee's Mandated Reporter Training Certification (2/15/22, expiration 2/15/24) was not current, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2024
Plan of Correction
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Licensee to provide CCLD (elvin.baddley@dss.ca.gov) current Mandated Reporter Certification no later than the closed of business (5:00 PM) on 9/23/24.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/interview/record review, the licensee did not comply with the section cited above in that Licensee's Pediatric First Aid/CPR Training (06/27/22, expiration 06/27/24) was not current, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2024
Plan of Correction
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Licensee to provide CCLD (elvin.baddley@dss.ca.gov) current Pediatric First Aid/CPR Training Certification no later than the closed of business (5:00 PM) on 9/23/24.
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:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


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: ROSE FCC AKA DOWNTOWN BABY SHELL BEACH
FACILITY NUMBER: 406214343
VISIT DATE: 09/09/2024
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LPA's reviewed children records. All records reviewed are current and complete. The records include children's immunization records as well as emergency contact information among other required licensing documentation. LPA's also reviewed the Licensee's records. At 10:50 AM, LPA's observed Pediatric CPR/First Aid (6/27/22, expiration 6/27/24) and Mandated Reporter (2/15/22, expiration 2/15/24) certifications which were not current. LPA's reminded Licensee certifications must be renewed every two years. Licensee informed LPA's no firearms or ammunition are stored on site.

The Licensee does not provide Incidental Medical Services (IMS) at this time. IMS policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing 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) or (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.

LPAs discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 09/09/24.
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 FCC AKA DOWNTOWN BABY SHELL BEACH
FACILITY NUMBER: 406214343
VISIT DATE: 09/09/2024
NARRATIVE
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Type B Deficiencies are being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC 102425(b) and CCR 102416 (c) (refer to LIC 809-D). Licensee was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Robin Rose.

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

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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