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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213577
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:21:41 PM

Document Has Been Signed on 09/17/2024 04:21 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:BAILEY FCC AKA PAULETTE'S PLAYHOUSEFACILITY NUMBER:
426213577
ADMINISTRATOR/
DIRECTOR:		BAILEY, PAULETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 819-0722
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Paulette and Kenneth BaileyTIME VISIT/
INSPECTION COMPLETED:
04:30 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
A Case Management Inspection was conducted by Licensing Program Analysts (LPAs) Sylvia Mendoza-Ceja and Elizabeth George. Licensee Paulette Bailey escorted LPAs through the home. LPAs observed a bassinet in one of the rooms during nap time. Licensee stated a parent provided it for their child for nap time. LPAs advised the bassinet is prohibited equipment. LPAs also observed medication and glass cleaner on the counter accessible to day care children. During the visit, Licensee Paulette Bailey had the bassinet, glass cleaner and medication removed.



The following Type B deficiencies are cited according to Child Care Regulations, Title 22, Division 12.

Appeal Rights were reviewed and provided to Licensee.

An exit interview was completed with Licensee Paulette Bailey.


FAILURE TO POST THE NOTICE OF SITE VISIT FOR DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Sylvia Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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
Document Has Been Signed on 09/17/2024 04:21 PM - It Cannot Be Edited


Created By: Sylvia Ceja On 09/17/2024 at 03:47 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: BAILEY FCC AKA PAULETTE'S PLAYHOUSE
FACILITY NUMBER: 426213577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2024
Section Cited
CCR
102425(a)

1
2
3
4
5
6
7
 Infant Safe Sleep: There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
During the visit, the item was removed from the home.
8
9
10
11
12
13
14
Based on observation, interview with Licensee and record review, the licensee did not comply with the section cited above. Licensee accepted a bassinet to be used for an infant which poses a potential health, safety or peonal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
09/17/2024
Section Cited
CCR102417(g)(4)

1
2
3
4
5
6
7
Operation of a FCCH: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The items were removed during the visit.
8
9
10
11
12
13
14
LPAs observed medication on the counter a parent left for a child. In addition, LPAs observed window cleaner on the counter which poses a potential health, safety or peonal rights risk to persons 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:Sylvia Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2