Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 08/28/2018
Date Signed 08/28/2018 05:29:02 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:LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOLFACILITY NUMBER:
426213750
ADMINISTRATOR:TERESE MUNOZ-HILLFACILITY TYPE:
850
ADDRESS:219 W. OLIVE AVENUETELEPHONE:
(805) 736-6210
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 67DATE:
08/28/2018
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Therese Munoz- HillTIME COMPLETED:
03:45 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 report was completed to document the deficiencies observed upon arrival to the center. When LPA arrived at 10:15 AM, LPA observed child #1 (from the #K classroom) to be unsupervised sitting in a chair watching the elementary school children on the playground. LPA asked child #1, why are you not in your classroom. Child #1 then ran around the restroom building.

LPA met with staff #1 and staff #4 who were in the restroom with four children. LPA advised staff #1 about child #1 not being supervised on the other side of the restroom. Staff #1 stated she was not aware child #1 was not supervised and went to get child #1. After interviewing staff #1 and staff #2; it was determined that staff #2 was sending some of the children from the #K classroom to the restroom and staff #1 was sending them back to #K classroom. Staff #1 stated she was assisting another child in the restroom and did not know child #1 had been sent to the restroom. It was determined child #1 was not supervised for up to a minute.

Based on observations and interviews with staff, and record review revealed the Licensee failed to be in compliance with the care and supervision of children.

The deficiencies cited under Title 22 Division 12 in regards to the above violations. Appeal rights provided.
Upon receipt, post and provide copies of this licensing report: to parents/guardians of children in care at the facility and to parents/guardian of children newly enrolled at the facility during the next 12 months. Licensee shall obtain signatures of parents/guardian on the Acknowledgement of Receipt of Licensing Reports LIC 9224.

LPA observed the Notice of Site Visit posted.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2018
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: LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOL
FACILITY NUMBER: 426213750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2018
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
-This requirement was not met as evidenced by LPA's observations and interviews with staff.
1
2
3
4
5
6
7
Please submit a written plan of correction to ensure this violation is not repeated.
8
9
10
11
12
13
14
When LPA arrived at 10:15 AM, LPA observed child #1 (from the #K classroom) to be unsupervised for up to a minute sitting in a chair watching the elementary school children on the playground which poses an immediate Health, Safety, or Personal Rights risk to children in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2018
LIC809 (FAS) - (06/04)
Page: 2 of 2