Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401702793
Report Date: 05/20/2016
Date Signed 05/20/2016 03:18:53 PM

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:ORFALEA FAMILY & ASI CHILDREN'S CENTER ROOM #133FACILITY NUMBER:
401702793
ADMINISTRATOR:TONYA IVERSEN - T5FACILITY TYPE:
830
ADDRESS:1 GRAND AVETELEPHONE:
(805) 756-1267
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93407
CAPACITY:36CENSUS: 28DATE:
05/20/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tonya IversenTIME 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
(3) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with Director, Tonya Iversen. The center was toured inside and outside. The classrooms are clean and free of toxins. LPA observed age appropriate toys, games, napping equipment (cribs and mats), changing table, and napping area.
The outdoor play area is completely fenced. LPA observed age appropriate toys, sand box, shade area.

There is a functioning carbon monoxide in each classroom.

Sampling of children's files reviewed. Medical assessment on file for each child's record reviewed. Sign in and sign out matched census. Needs and Services plan reviewed. Center maintains separate and complete records for each child enrolled.

Teachers files reviewed. Teachers are current with CPR and First Aid which expires August 21, 2017.

Center will be providing Incidental Medical Services.


Today, no deficiencies cited under Title 22 Division 12.






LPA observed Director post the Notice of Site visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2016
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 1