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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211192
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:33:40 AM

Document Has Been Signed on 05/04/2023 11:33 AM - 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:PVSD-DOS CAMINOS ELEMENTARY SCHOOLFACILITY NUMBER:
566211192
ADMINISTRATOR:MARK ASHERFACILITY TYPE:
850
ADDRESS:3635 APPIAN WAYTELEPHONE:
(805) 482-9894
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 19DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Stephanie LawsonTIME COMPLETED:
11:48 AM
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 May 4th, 2023, at 9:03am Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with Lead Teacher Rebecca Ojeda and Program Director Stephanie Lawson and advised the purpose of the inspection. Teacher provided LPA a tour of the facility inside and out. This facility is on the grounds of Dos Caminos Elementary School and program hours of operation are Monday through Friday 8am – 11am and 12pm – 3pm. At the time of the inspection there were nineteen (19) children, and three (3) staff present.

LPA observed required licensing documents mounted on the wall at the entrance of the facility. Parents use electronic app Learning Genie for the purposes of signing in and out. The facility is currently utilizing one (1) classroom for care and supervision. LPA observed children have individual cubbies to store personal items. Classroom has ample ventilation, age-appropriate toys, and furniture readily accessible for children in care. LPA observed the facility to have a variety of daily activities to meet the needs of the children. Children bring their own water bottles and facility also provides filter water for use. LPA observed all cleaning compounds, disinfectants, sharps, combustibles, and tools to be elevated and / or locked in a cabinet. Teacher stated classrooms are cleaned every evening by a janitorial service. LPA observed the facility has a sufficient number of restrooms and sinks available for the children, which were functioning and clean at the time of the inspection. Facility provides snacks and LPA observed kitchen to be clean, free of rodents, and appliances in working order. Fire extinguisher was last serviced on 8/11/2022. First aid kits are available. Per director, no firearms or ammunition are present on property.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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 3
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: PVSD-DOS CAMINOS ELEMENTARY SCHOOL
FACILITY NUMBER: 566211192
VISIT DATE: 05/04/2023
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
LPA observed the outdoor area play area to have ample amount of space for children to play with appropriate toys and equipment. LPA observed shade, and soft padding. No bodies of water are present.

Incident Medical Services are not being provided at this time.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Teacher Mandated Reporter Certificates are valid through 8/21/2023. LPA reviewed SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications.

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

No deficiencies were cited during today’s inspection.

Technical assistance was provided.

Exit interview conducted, report reviewed, and copy provided to director.

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 APPLY.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3