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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216029
Report Date: 09/28/2021
Date Signed: 09/28/2021 01:15:05 PM

Document Has Been Signed on 09/28/2021 01:15 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:ADVENTIST EDUCATION SIMI VALLEY PRESCHOOLFACILITY NUMBER:
566216029
ADMINISTRATOR:STEPHEN STOKESFACILITY TYPE:
850
ADDRESS:1636 SINALOA RD.TELEPHONE:
(805) 210-8353
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tammy GrodtTIME COMPLETED:
01:20 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 28, 2021 at 11:00 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA contacted the facility and conducted Covid-19 screening questions prior to entering the facility. LPA met with facility Director Tammy Grodt and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There was six (6) children in care at the time of the inspection. Facility hours of operation are Monday thru Friday 7:00 AM - 6:00 PM. This is a combined center with an infant license.

Facility uses one classroom for children in care. LPA observed required licensing documents mounted on the wall at the entrance of the classroom. Facility does not have a snack schedule. Children bring their own lunch and daily snacks from home. Facility has two restrooms available for children in care. One restroom is closed and they are currently only using one restroom because of the amount of children enrolled at this time. The restroom has two (2) sinks and three (3) toilets available. LPA did not observe any hazards/toxins items accessible to children in care. LPA observed the classroom to have enough books, toys, activities, and furniture readily accessible for children in care. The facility provides cots for children to use during quiet time after lunch if they choose to sleep. Children that do not sleep are provided a quiet activity during the quiet time. The outdoor playground has an ample amount of space for children to play. LPA observed the playground has age appropriate toys, a sandbox, and structure available for children to use. The playground has ample amount of shade available.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216029
VISIT DATE: 09/28/2021
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
The facility has water available for children inside and out. Facility refills children's water with a filtered water faucet. Children use their own water bottles if they have them labeled with their name.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility does not have children that require Incident Medical services (IMS). LPA observed staff files to be complete and current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. Teachers present have current Pediatric CPR/First-Aid certificates that are valid until 10/13/22. Teachers have current Mandated Reporter certificates that are valid until 3/27/22. LPA spoke with Director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines.



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.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2