Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215048
Report Date: 08/17/2017
Date Signed 08/17/2017 11:58:42 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:SOMIS COMMUNITY PRESCHOOLFACILITY NUMBER:
566215048
ADMINISTRATOR:NELLUM LEWISFACILITY TYPE:
850
ADDRESS:3300 WEST STREETTELEPHONE:
(805) 844-6093
CITY:SOMISSTATE: CAZIP CODE:
93066
CAPACITY:46CENSUS: 19DATE:
08/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Nellum LewisTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mingle made an unannounced visit in order to conduct an Annual/random review and met with the director, Ms. Nellum Lewis. The purpose of the visit was discussed and a tour of the facility was conducted. LPA observed Ms. Lewis and another staff together with 9 children on the playground upon arrival.
There were no bodies of water present. Ms. Lewis stated that the center has no firearms on site. The center uses 3 classrooms for the preschool. These classrooms were toured and found free of hazards. Solid waste bins had fitting lids. Surface of classrooms floors were carpeted. Drinking water was available in individual, labelled bottles.
Outdoor space was fully fenced. LPA observed the center using part of the parking lot, aligned with cones, for the children to ride their tricycles with teachers present. LPA discussed the need for the center to request for a waiver or stay within the confines of their playground.
Playground toured was fully fenced. The surface was all sand and free of hazards. High climbing equipment had enough cushion beneath to absorb a fall.
Staff present had required qualifications and experience to function in their respective roles. By review of files, LPA determined that staff were complaint with immunization requirement for providers as mandated by Senate bill 792(Mendoza). Staff present had current CPR/First aid certification with an expiration of 5/13/19. All adults present have obtained a criminal record clearance. The center maintains a log for fire and emergency disaster drills. Last drill was logged on 7/17/2017. Sign in/out sheet reviewed were missing sign in for two children present.
Children files reviewed had proof of immunization and emergency information. Ms. Lewis stated that there were no children on prescribed medication currently.
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
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
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: SOMIS COMMUNITY PRESCHOOL
FACILITY NUMBER: 566215048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2017
Section Cited
101229.1(b)
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The person who brings the child to, and removes the child from, the center shall sign the child in/out.


Sign in an out sheet reviewed were missing two children present.
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Then center will provide a written statement to the department by close of business 8/24/2017 explaining how this occurred with measures to address and prevent future occurrence.
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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: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
LIC809 (FAS) - (06/04)
Page: 3 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: SOMIS COMMUNITY PRESCHOOL
FACILITY NUMBER: 566215048
VISIT DATE: 08/17/2017
NARRATIVE
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The following deficiency was cited today:
- Sign in and sign out. See attached LIC809D.
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3