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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710528
Report Date: 09/15/2021
Date Signed: 09/15/2021 03:22:47 PM

Document Has Been Signed on 09/15/2021 03:22 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:BETHANIA PRE-SCHOOLFACILITY NUMBER:
421710528
ADMINISTRATOR:LOLA GONZALEZFACILITY TYPE:
850
ADDRESS:611 ATTERDAG ROADTELEPHONE:
(805) 688-7077
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 46TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
09/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Lola GonzalezTIME COMPLETED:
02:00 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 September 15, 2021 at 11:55 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual required inspection of the above mentioned Child Care Center (CCC). Prior to inspection, LPA asked pre screening questions related to COVID 19, Director's responses indicate there was no COVID exposure on site. LPA met with Lola Gonzalez , Director of the CCC and explained the nature of the inspection. LPA, in the company of the Director toured the interior and exterior of the CCC. There were 30 pre school children, 5 qualified teachers, director and 2 aides present.

During the tour, the following was observed, The CCC utilizes 4 classrooms for pre school, Classrooms are adequately equipped with age and size appropriate furniture and equipment. Each classroom has carbon monoxide detector. Licensing required forms and menu are posted in prominent location. Water jug supplies drinking water in the indoor activity space. Playground is enclosed by an appropriate fence. Outdoor activity area is equipped with age and size appropriate equipment. An adequate amount of cushioning material is in place under play equipment. Adequate shade is available. Drinking water is provided in the outdoor play area by a water jug and water pitcher.

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. A review of staff records on 9/15/2021 indicates that all facility staff have criminal record clearance. Center staff has current Pediatric which expires on 7/22/2023. Sign in and sign out record meets the regulation requirements. AB 1207 Mandated Reporter Training Certificate expires on 3/26/2022.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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 2
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: BETHANIA PRE-SCHOOL
FACILITY NUMBER: 421710528
VISIT DATE: 09/15/2021
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 noted no firearms or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. 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.htmhttp://www.ada.gov/childqanda.htm

In areas evaluated, there was no deficiency cited under Title 22 Division 12 and Health and Safety Code.


THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL BE ASSESSED.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2