406216447-10-19-2022-17-CC-EBAY-CKCSSZ-20221019140845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406216447
Report Date: 10/19/2022
Date Signed: 10/19/2022 02:11:14 PM

Document Has Been Signed on 10/19/2022 02:11 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:	ARROYO GRANDE MONTESSORI		FACILITY NUMBER:	406216447
ADMINISTRATOR:	ELIZABETH SILVA		FACILITY TYPE:	850
ADDRESS:	216 OAK STREET		TELEPHONE:	(805) 473-2979
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 10	DATE:	10/19/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Silva		TIME COMPLETED:	02:15 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 10/19/22, at 1:00 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicense Inspection of the abovementioned Child Care Center (CCC) given a change of ownership from DEJ INC- Michael Miller to DEJ INC- Andrew Silva.and Elizabeth Silva. LPA met with Elizabeth Silva , Director of the CCC and explained the purpose of the inspection. LPA, in the company of Director, toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 3:30 PM, Monday - Friday. The preschool uses a great room and an outdoor play area for child care services. LPA observed 10 children on site at the time of the inspection. The CCC's classroom is clean and well organized. The classroom has age appropriate toys and furnishings available for children in care. LPA observed the restroom area used by children in care to be clean and free of toxins. The CCC has an operable refrigerator which contained food and beverages. LPA notes children in care bring lunches from their homes, while the CCC provides snacks. The CCC affords the children filtered water both inside the CCC and in the exterior. The CCC does not use facility drinking water sources (i.e. fountains) and the Director was reminded of the need to test the CCC water sources for lead containments. LPA observed a facility menu posted as well as required licensing documents near the CCC's main entry/exit. The CCC uses an electronic sign in and sign out system. The CCC has an operable carbon monoxide detector. Disinfectants and cleaning solutions are observed on an elevated shelf in the CCC's restroom area which is inaccessible to children in care. Medication is on the premises is stored in an elevated cabinet and inaccessible to children in care. The CCC’s outdoor playground area, which is comprised of varied footing is enclosed by chain linked fencing. The fence’s entry/exit gates are secured. LPA observed age appropriate toys and play equipment in the play area. The toys and play equipment are in suitable condition and free of sharp, loose or pointed objects. (CONT. 809-C)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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: ARROYO GRANDE MONTESSORI	FACILITY NUMBER: 406216447
	VISIT DATE: 10/19/2022

NARRATIVE

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LPA observed the play structures in the playground area have adequate cushioning materials (i.e. rubber chips) to absorb falls and shade covering in the area provided by tree and building overhangs. LPA observed a shed in an excluded area of the outdoor which contains CCC supplies. The shed is secure. No bodies of water were observed on site.. Waste receptacles with tight fitting covers were observed throughout the center.
The records of staff and children's on site was reviewed (8/5/22). The children’s records were complete and found to contain emergency contact information and well as immunization records. Staff records were reviewed and contain current pediatric CPR/First Aid (EMSA approved) as well as current Mandated Reporter certificates. LPA notes no firearms or ammunition is stored on site.

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

Facility representative were reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Director is reminded to ensure designation of Administrative authority and staffing assignments are current and reported to CCLD as need be.

A Notice of Site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Elizabeth Silva.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

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