406216618-8-1-2023-17-CC-MBRT-CUASTL-20230801140942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406216618
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:09:49 PM

Document Has Been Signed on 08/01/2023 02:09 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:	PEACE CHRISTIAN PRESCHOOL & INFANT CENTER		FACILITY NUMBER:	406216618
ADMINISTRATOR:	DORIS ANGEL		FACILITY TYPE:	830
ADDRESS:	244 N. OAK PARK BLVD		TELEPHONE:	(805) 489-9644
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 0	DATE:	08/01/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Doris Angel		TIME COMPLETED:	02:15 PM

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On August 1^st, 2023, at 1:08PM Licensing Program Analysts (LPAs) Rosie Breault and Susana Martinez conducted an announced Pre-Licensing inspection. LPA met with Director Doris Angel and advised her the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. There were no children in care at the time of the inspection. This facility is located on the grounds of Peace Lutheran Church and is a combination center with a Preschool Program. Facility operating hours are Monday through Friday 8:30 AM to 4:30 PM.

LPA observed the required licensing documents mounted on the wall at the entrance of the facility. The facility will be using one (1) classroom for children in care, one (1) gated and fenced outdoor play yard that is separated from preschool children. LPAs observed age-appropriate toys, activities, and furniture readily accessible for children in care. At the time of the inspection, classroom was clean, and orderly with soft carpeting for cushion. Classroom contains one (1) changing table with sink within arm’s reach and separated nap area with individual cribs for nap time. LPAs reminded director to adhere to Safe Sleep policy, to document 15 Minute Sleep Checks, and teacher to child ratio of one (1) teacher to four (4) infants and or one (1) fully qualified teacher and two (2) aids for twelve (12) infants. Classroom has one (1) refrigerator to store food and milk that was functioning at the time of the inspection. LPAs tested combination Carbon Monoxide and Smoke Detector at 1:22PM and was functioning at the time of the inspection. Fire extinguisher was last serviced on 4/10/2023.

Outdoor play area has age-appropriate toy and furnishings with grass to absorb falls. LPAs observed play yard to be gated with permitter fencing and no bodies of water are present.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

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: PEACE CHRISTIAN PRESCHOOL & INFANT CENTER	FACILITY NUMBER: 406216618
	VISIT DATE: 08/01/2023

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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 follow 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

Director was 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.

LPAs reviewed with the director LIC 311A Records to Be Maintained At The Facility. Director was made aware that it is the facility's responsibility to know the current regulations for a CCC which can be accessed on-line at www.cdss.ca.gov.

Facility was reminded all water sources are to be tested for contamination 180 days after licensing.

Five Cities Fire Authority conducted inspection on 6/23/2023 and cleared facility licensure.

This facility meets Title 22 Division 12 for an Infant Center, capacity twelve (12) effective today August 1^st, 2023. Exit interview conducted, copy provided to Director.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC809 (FAS) - (06/04)

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