<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215269
Report Date: 07/21/2021
Date Signed: 07/21/2021 04:38:42 PM

Document Has Been Signed on 07/21/2021 04:38 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:ADVENTURE KIDSFACILITY NUMBER:
406215269
ADMINISTRATOR:EVELYN CHOTOFACILITY TYPE:
850
ADDRESS:880 MANZANITA DR. RM # 5 & 6TELEPHONE:
(805) 439-4911
CITY:LOS OSOSSTATE: CAZIP CODE:
93402
CAPACITY: 43TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Evelyn ChotoTIME COMPLETED:
04:50 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 7/21/21, Licensing Program Analyst (LPA) Francisca Velazquez and Licensing Program Manager (LPM) Maria Mueller conducted an unannounced Required inspection the Child Care Center (CCC). The LPAs met with Evelyn Choto, Director of the CCC and explained the purpose of the inspection. LPA and LPM, in the company of the Director toured the interior and exterior of the CCC. The center operates from 7:30 AM to 5:00 PM, Monday - Friday. This is a combine center with infant, preschool and school-age program. At the time of the inspection, twelve (12) preschool children were present, along with one teacher, in addition to the Director. During the inspection another staff member arrived at the facility.

The CCC has two (2) preschool classrooms. The CCC has proper ventilation to afford for child care children. LPA observed age appropriate toys and furnishings throughout the CCC. LPA advised Director to remove broken toys and to ensure outdoor play material is free of insects and spider webs. LPA observed carbon monoxide and smoke detectors in each classroom. The detectors were tested by Director and found to be operational and functioning at 11:30 AM and 11:38 AM. The CCC's bathroom used are in the Preschool classroom. LPA advised Director to maintain the restroom and carpet clean for children in care. The CCC’s bathroom has two (2) toilets and four sinks (4) sink accessible to the children in care. There is also another restroom in the play yard. Director stated that at the moment, the CCC is only using the toilets in the Preschool classroom. The CCC has an operable refrigerator. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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 5
Document Has Been Signed on 07/21/2021 04:38 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 07/21/2021 at 02:37 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: ADVENTURE KIDS
FACILITY NUMBER: 406215269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2021
Section Cited
CCR
1012166(f)

1
2
3
4
5
6
7
1012166(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...child care center or offsite for center activities. This requirement was not met as evident by:
1
2
3
4
5
6
7
Director stated she will register to complete pediatric cardiopulmonary resuscitation and pediatric first aid and submit proof by email to francisca.velazquez@dss.ca.gov by 7/28/21.
8
9
10
11
12
13
14
Based on record review it was determined that there is no CCC staff with current CPR/Frist-aid card. This poses a potential risk to the health and safety of the children in care.
8
9
10
11
12
13
14
Type B
07/28/2021
Section Cited
CCR101238(a)

1
2
3
4
5
6
7
101238(a)-Buildings and Grounds- (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evident by:
1
2
3
4
5
6
7
Director stated she will create a plan to ensure that all CCC areas are clean, safe, sanitary and in good repair and will submit by email to francisca.velazquez@dss.ca.gov by 7/28/21.
8
9
10
11
12
13
14
During inspection, LPA observed dirty toliets and crumbs and dirt on the carpet of the preschool classroom. This poses a potential risk to the health and safety of the children in care.
8
9
10
11
12
13
14
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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2021


LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ADVENTURE KIDS
FACILITY NUMBER: 406215269
VISIT DATE: 07/21/2021
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
26
27
28
29
30
31
32
 Director stated that since COVID-19 children bring their lunches. Additionally, the children bring their own bottled water. Disinfectants and cleaning solutions are stored on top of the refrigerator in the classroom. LPA observed napping equipment with blankets accessible for children in care.

LPA observed a menu posted alongside the refrigerator, however Director stated that at the moment it is not being followed due to children bringing their own lunches from home. LPA


observed CCC license and required notices posted in the Preschool classroom. LPA observed a Sign In/Out form near the CCC's entry. During today’s inspection only (nine) 9 out of the twelve (12) children present were properly signed in. The three (3) children that were not signed in were Director’s three children. LPA reminded Director that all children should be sign in if present at the facility.

LPA observed that backyard is completely fenced. LPA observed age appropriate toys/play equipment in the play area. LPA advised Director to remove broken toys that could be hazardous to children in care. In addition, Director was asked to add locks to the gates separating the backyards. LPA observed a pole that was sticking out with nail that could be hazardous to the children in care. Director informed LPA and LPM that the school district needs to fix the pole. Director has placed a work order and stated that someone will be out to fix the pole this Friday 7/23/21. No bodies of water were observed on site.

The Director stated there are no firearms/weapons or ammunition that are stored on the premises.

CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: ADVENTURE KIDS
FACILITY NUMBER: 406215269
VISIT DATE: 07/21/2021
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
26
27
28
29
30
31
32
A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as medical assessments. LPA advised Director that children immunization's should be in blue paper. Staff records were reviewed. Staff #1 file did not have current CPR which expired 6/13/20. Staff #1 has current AB1207 that expires 7/25/21. Staff #2 file did not have current CPR which expired 6/13/21. Staff #2 has current AB1207 on file that expires 7/25/21. After staff file review, it was determined that there was no current CPR certified staff in the facility.

This facility does not provide Incidental Medical Services – IMS. 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

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

Based on LPAs observations, deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:


CON 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ADVENTURE KIDS
FACILITY NUMBER: 406215269
VISIT DATE: 07/21/2021
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
26
27
28
29
30
31
32
Exit interview conducted with Director Evelyn Choto. A copy of the Appeal Rights were given and explained. Director’s signature on this form acknowledges receipt of these rights.

LPA observed Director post the Notice of Site visit (LIC 9213).

CONT 809-D

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5