Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 11/16/2018
Date Signed 11/16/2018 05:06:56 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: 59DATE:
11/16/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Terese Munoz-HillTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ruth Gull and Sylvia Mendoza-Ceja made an unannounced CASE MANAGEMENT visit to the center. Met with Terese Munoz-Hill, Director regarding an incident that was self-reported on 10/08/18. LPAs toured the area where the incident occurred and interviewed Director and staff.

On 10/05/18, at approximately 7:30am, the children were in the playground (there were 6 teachers with 35 children at the time of the incident). One of the younger children had a toileting accident which left a puddle of urine on the wooden stage. A teacher took the child to get changed and Teacher #18 cleaned the stage (another teacher brought the cleaning supplies). Teacher #18 briefly set the spray bottle of disinfectant on the top of one of the stage railings (approximately 4 feet high) while she wiped the floor area with paper towels. Teacher #18 states that there were no children near her at the time. Teacher #9 then observed Child #1 pick up the spray bottle and spray it once before Teacher #9 could get to her and take it away. Child #4 was close by and was misted on. Teacher #9 states that she examined Child #4 and that her face and eyes were not wet. Teacher #9 cleaned Child #4's face with soap and water and Child #4 was monitored throughout the day until she left at 12:30pm (regular pick up time). Child #4's parent was notified at time of pick up. Child #4's parent did not seek medical attention for Child #4 and informed staff that Child #4 appeared fine .

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).

Exit interview conducted. Today's reports were reviewed and issued. The Director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

The LIC 9213 (Notice of Site Visit) was posted during today's visit.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2018
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: LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOL
FACILITY NUMBER: 426213750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2018
Section Cited
CCR
101223(a)(2)
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101223(a)(2) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement was not met as evidenced by:
Record review and interview with Director and staff. Child #1 picked up a spray bottle of disinfectant that Teacher #18 had briefly set
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Director states she will submit a written plan regarding how this will be prevented in the future. Submit the plan to CCL by 11/19/18
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on the top of a railing, and sprayed it once before Teacher #9 could take it away. Child #4 was close by and was misted on. Child #4 was examined (her face and eyes were not wet). Staff cleaned Child #4's face with soap and water.Child #4 did not have an adverse reaction. This poses a potential safety risk to children in care
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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: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2018
LIC809 (FAS) - (06/04)
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