Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214335
Report Date: 02/07/2018
Date Signed 02/07/2018 11:42:58 AM

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:NIPOMO RECREATION-LITTLE BITS PRESCHOOL & TODDLERFACILITY NUMBER:
406214335
ADMINISTRATOR:NANCY MAROHNFACILITY TYPE:
850
ADDRESS:112 ORCHARD ROADTELEPHONE:
(805) 929-5437
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:60CENSUS: 26DATE:
02/07/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathy BumgardnerTIME COMPLETED:
12:00 PM
NARRATIVE
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(2) Licensing Program Analysts (LPAs) Maria Mueller and Juvenal Moctezuma conducted an annual random visit and met with Kathy Bumgardner. The center was toured inside and outside. The preschool operates 7:00 am to 5:30 pm. The center classroom was found clean and free of toxins. Sign in and sign out matched census. The menu is posted inside the classroom.
The outdoor play area is completely fenced. LPA observed age appropriate play structure, bike area, shade area and toys.

Center is not providing Incidental Medical Services. 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

Teachers files reviewed. CPR expired in September 2017.
LPAs reviewed sampling of children's records, Identification and Emergency form reviewed.



In areas evaluated, deficiency cited under Title 22 Divsion 12. Appeal right provided.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
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: NIPOMO RECREATION-LITTLE BITS PRESCHOOL & TODDLER
FACILITY NUMBER: 406214335
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2018
Section Cited
CCR
10127(a)(6)
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Personnel Requirements. At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities.

Director and teachers certificate for CPR and First Aid expired 9-2017.
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Director will submit the copy of CPR and First Aid certificates by March 7, 2018
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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: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
LIC809 (FAS) - (06/04)
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