Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 03/07/2019
Date Signed 03/07/2019 02:29:48 PM

COMPREHENSIVE INSPECTION
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: 73DATE:
03/07/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Terese Munoz-HillTIME COMPLETED:
02:45 PM
NARRATIVE
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A comprehensive inspection was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and M. Stewart who met with Terese Munoz-Hill. The center was toured inside and outside. The classrooms were observed to be clean and orderly. The children's restroom was inspected. There is carbon monoxide detector in the classroom. The last fire and safety drill was conducted 3/7/2019 which is documented. The medication was inspected and found that the medication was accepted for child #1 which did not have the child's name, date, or prescription label. The first aid kit was inspected. The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records, including the sign in/out sheets. Staff records were reviewed. LPA reviewed current CPR and First Aid for 5 staff working today. The requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles was reviewed. LPA reminded, each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or obtain a sign statement declining the influenza vaccination. LPA also reviewed certificate of completion of the AB 1207 Child Mandated Reporter Training for staff. LPA also reviewed the handout “A Child Care Provider’s Guide to Safe Sleep and the Effects of Lead Exposure."
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

The following Type A and B deficiencies are cited on page #2 and #3 according to CCR, Title 22 Division 12 Regulations. 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: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2019
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 3
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: 03/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/07/2019
Section Cited
CCR
101226(e)(2)(3)(A)
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101226 (e) (2) (3) (A) Health-Related Services- All prescription and nonprescription medications shall be maintained with the child's name and shall be dated. Prescription medications may be administered if all of the following conditions are met: Prescription medications shall be administered in accordance with the label
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During the visit, the director contacted the parent who came to the center to retreive the medication so that she can get the prescription labeled with the child's name and date. POC: Director stated she will review Health-Related Services and submit a plan to ensure this violation is not repeated by 03/14/2019.
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directions as prescribed by the child's physician. --This requirement was not met as evidenced by interview with director, review of records, & medication for child #1. LPA inspected the medication which did not have child #1's name, date, or prescription label maintained at the center.
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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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 03/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2019
Section Cited
CCR
101216(g)(3)(B)
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101216(g)(3)(B)Personnel Requirements
Results of a test for tuberculosis performed not more than one year prior to or seven days after initial presence in the center.
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Please submit verification to Licensing for review by 03/14/2019.
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Review of staff records revealed the Licensee failed to obtain verificaiton of the tuberculosis clearances for staff #5 and #8 which poses a potential health and safety risk to children in care.

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Type B
03/14/2019
Section Cited
HSC
1596.7995(a)(1)
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1596.7995 (a)(1) Health and Safety - Employees/volunteers at day care center; immunization requirements; records; exemption: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles....
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Please submit verification to Licensing by 03/14/2019.
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This requirement was not met as evidenced by the review of staff records which revealed staff #3 is missing verification MMR which poses a potential health and 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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2019
LIC809 (FAS) - (06/04)
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