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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712405
Report Date: 06/29/2022
Date Signed: 06/29/2022 01:11:30 PM

Document Has Been Signed on 06/29/2022 01:11 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:GIRLS INCORPORATED OF CARPINTERIAFACILITY NUMBER:
421712405
ADMINISTRATOR:COLLINS, JAMIEFACILITY TYPE:
840
ADDRESS:5315 FOOTHILL ROADTELEPHONE:
(805) 684-6364
CITY:CARPINTERIASTATE: CAZIP CODE:
93013
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 38DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Gloria FloresTIME COMPLETED:
01:25 PM
NARRATIVE
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On June 29, 2022 at 10:30 AM, Licensing Program Analyst (LPA) Francisco Pedroza and (LPA) Rona Chavez conducted an unannounced Annual/Random inspection. LPAs met with Operations Director Gloria Flores and advised her the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. There were 38 children in care and six (6) staff supervising.

The facility is using five (5) classroom for children in care. LPAs observed licensing required documents posted prominently on the wall at the entrance of the facility. The center has sufficient amount of restrooms for the children to use. LPAs observed age appropriate toys, activities, books, and furniture readily accessible for children to use. The center provides snacks for children while in care. Children bring their own lunch. Facility is currently providing Incidental Medical Services (IMS) to children in care. Children share large grass area and playground for outdoor recreation. Children have access to water inside and out. Some children bring their own water bottle from home.

LPAs observed the sign-in/sign-out sheet current. LPAs reviewed a sampling of children and staff records. Children records were complete and current. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Staff present were fully qualified with current Mandated Reporter and CPR/First-aid certificates. The last fire drill was completed on 05/11/2022. Facility is following current Covid-19 guidelines.

On June 29, 2022 at 11:45 AM, during staff record reviews, LPA's observed two staff present and supervising children have not received a cleared criminal record clearance or exemption. LPA's informed Director about the two staff that did not have a cleared criminal record clearance or exemption.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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: GIRLS INCORPORATED OF CARPINTERIA
FACILITY NUMBER: 421712405
VISIT DATE: 06/29/2022
NARRATIVE
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Director advised LPA's that she knew about one of the staff did not receive a livescan. She advised the facility they go to for livescan was closed at the time. Director did not know about the other staff since they were worked at the facility the previous year. All individuals subject to criminal record review are required to have a criminal record clearance or exemption prior to working, residing, or volunteering in licensed facility. The following California Code of Regulations, (Title 22, Division 12 & Chapter 1) are being cited on the attached LIC809D(s) with a civil penalty.

One type A violation was cited during today's inspection.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director. Director was provided Appeal Rights.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/29/2022 01:11 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Francisco Pedroza On 06/29/2022 at 12:43 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: GIRLS INCORPORATED OF CARPINTERIA
FACILITY NUMBER: 421712405

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 8 persons have not received a criminal record clearance or exemption which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2022
Plan of Correction
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Director must provide proof of livescan for the two (2) staff without a criminal record clearance or exemption no later than July 13, 2022 to CCL via mail, fax, or email to francisco.pedroza@dss.ca.gov.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022


LIC809 (FAS) - (06/04)
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