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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215411
Report Date: 05/03/2022
Date Signed: 05/03/2022 03:11:55 PM

Document Has Been Signed on 05/03/2022 03:11 PM - It Cannot Be Edited

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:ROULLO FCC AKA HAPPY HEARTS PRESCHOOLFACILITY NUMBER:
426215411
ADMINISTRATOR:CYNTHIA RENAE ROULLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 260-3105
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Cynthia Renae RoulloTIME COMPLETED:
03:10 PM
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On May 3, 2022 at 12:10 PM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required inspection and met with Licensee, Cynthia Roullo LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA discussed the purpose of the inspection. There were 11 children and 2 staff present during the inspection.

LPA in the company of Licensee toured the interior and exterior of the day care. FCCH uses the living room, bathroom, kitchen, dining, backyard for day care. LPA observed required licensing forms are posted in the FCCH. LPA observed smoke and carbon monoxide detectors in the home. Bathroom is toxin free. The regulation fire extinguisher was purchased on 3/24/2022.. Home conducts and documents fire and disaster drill every month, last drill was conducted on 4/13/2022. The backyard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 3/20/2023. Licensee and Staff renewed the Mandated Reporter Training Certificate which expires on 7/31/2022. Licensee was reminded to renew the Mandated Reporter Training. Licensee and Staff have proof of immunization on file. FCCH has current roster of children in care.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2022
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: ROULLO FCC AKA HAPPY HEARTS PRESCHOOL
FACILITY NUMBER: 426215411
VISIT DATE: 05/03/2022
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The children's records were reviewed and found to be current. File contains Emergency and Identification card requirements. Currently the licensee carries liability insurance.

Licensee implements the COVID 19 Mitigation Plan, pre screening, temperature checking, handwashing and disinfecting.

No deficiencies were cited during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. When any IMS is provided, a plan for providing 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Continued on LIC 809 C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
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