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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566205947
Report Date: 07/07/2022
Date Signed: 07/07/2022 12:16:45 PM

Document Has Been Signed on 07/07/2022 12:16 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:STENBERG FCC AKA PEGI'S CHILD CARE & PRESCHOOLFACILITY NUMBER:
566205947
ADMINISTRATOR:PEGI STENBERG/LEGALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 857-4436
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:PEGI STENBERGTIME COMPLETED:
12:30 PM
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On 7/7/2022 at 9:30 Am Licensing Program analyst (LPA) Michael Mathew Conducted an unannounced annual visit LPA met with Licensee Pegi Stenberg and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA toured inside and out of the home. At the time of the visit there were 7 children and 3 adults. There are age appropriate toys and equipment for children in care.

Licensee uses the living room, classroom, playroom, hallway bathroom, Playroom bathroom,1 bedroom, and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed a fireplace which is fully covered by a metal gate. LPA observed the knifes were kept on top of the fridge away and inaccessible to children. LPA observed chemicals and toxins are kept above the kitchen pantry which is inaccessible to children in care. Backyard is fully fenced in and have ample amount of toys and equipment for children in care. LPA observed backyard sectioned off with a fence preventing children from having access. LPA observed no bodies of water during inspection. LPA observed a dog at the facility , licensee states that the dog does interact with the children. LPA reviewed dogs immunization to be current. LPA observed a 2A10BC fire extinguisher present and serviced on 11/9/21. Fire alarm and carbon monoxide detector are good and in working condition. Licensees and A2 CPR/first aid is current and is valid until 2/5/23. Licensee and A1 present have current mandated reporter training valid until 2/17/24 and 3/4/24. LPA observed that A2 present did not have a current Mandated reporter training. A2's Mandated reporter training was last completed on 1/4/2018. Fire drill was conducted on 5/25/22.


Cont 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: STENBERG FCC AKA PEGI'S CHILD CARE & PRESCHOOL
FACILITY NUMBER: 566205947
VISIT DATE: 07/07/2022
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The facility is currently not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

"1 type B deficiency was cited in today’s visit".

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
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Document Has Been Signed on 07/07/2022 12:16 PM - It Cannot Be Edited


Created By: Michael Mathew On 07/07/2022 at 11:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: STENBERG FCC AKA PEGI'S CHILD CARE & PRESCHOOL
FACILITY NUMBER: 566205947

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee stated that A2 might have forgot about the mandated reported traning or did not provided the completed certificate to licensee
POC Due Date: 07/11/2022
Plan of Correction
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Licensee agreed to send completed Mandated reporter training to LPA via email or text by end of day Monday (7/11/22)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Mingle
LICENSING EVALUATOR NAME:Michael Mathew
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


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