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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216029
Report Date: 07/08/2026
Date Signed: 07/08/2026 01:41:22 PM

Document Has Been Signed on 07/08/2026 01:41 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ADVENTIST EDUCATION SIMI VALLEY PRESCHOOLFACILITY NUMBER:
566216029
ADMINISTRATOR/
DIRECTOR:		TAMMY GRODTFACILITY TYPE:
850
ADDRESS:1636 SINALOA RD.TELEPHONE:
(805) 210-8353
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 20DATE:
07/08/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Judith DelarosaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 7/08/2026, at 8:30AM, Licensing Program Analyst (LPA) Seena Parsapour conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). At the time the inspection began, LPA met with lead teacher Rachael Fowler and explained the nature & purpose of the inspection, who advised that Facility Representative Judith Delarosa was enroute to the facility. LPA notes Facility Representative arrived at approximately 9:45am. LPA explained the nature & purpose of the inspection to Facility Representative and, in the company of Facility Representative, toured the interior & exterior of the CCC. The CCC is open Monday-Friday from 7:00am-6:00pm. At the time of the inspection, LPA observed twenty (20) children under the care & supervision of two (2) staff members (cleared & associated).

LPA observed required licensing forms and documents posted prominently near the classroom entrance, including a daily activities schedule. LPA observed paper sign in/out logs being used for children in care. LPA notes the forms contained the arrival and departure times of children in care as well as the signatures of the children's authorized representatives. The classrooms have age-appropriate play equipment and furnishings available to children in care. LPA observed disinfectants, cleaning solutions, sharps, and other potentially hazardous items stored in areas inaccessible to children in care. LPA observed a first-aid kit stored in an accessible location. LPA observed separate smoke & carbon monoxide detectors installed in the classroom, tested for functionality and verified operational at 9:41am. At 10:05am, Facility Representative informed LPA that a fire/disaster drill has not been conducted/documented within the last six (6) months. Facility Representative, during discussion with LPA, confirmed their understanding of the requirement that such drills be conducted & documented every six (6) months, and after this discussion, LPA observed a fire/disaster drill was conducted & documented during the inspection. A Technical Violation (TV) was issued. (CONT. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2026
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 9
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/08/2026 01:41 PM - It Cannot Be Edited


Created By: Seena Parsapour On 07/08/2026 at 12:31 PM
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: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the LIC701 was not on file for Child #01 (C1), C2, C4, & C5, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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Facility Representative shall submit to the Department ([email protected]) the LIC701 for C1, C2, C4, & C5 as well as a written statement explaining how they will ensure compliance with this regulation moving forward, no later than 7/17/2026.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that immunization records were not on file for C1 & C2, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/17/2026
Plan of Correction
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Facility Representative shall submit to the Department ([email protected]) immunization records for C1 & C2, as well as a written statement explaining how they will ensure compliance with this regulation moving forward, no later than 7/17/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Seena Parsapour
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2026


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216029
VISIT DATE: 07/08/2026
NARRATIVE
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The CCC has adequate restrooms and handwashing facilities for children in care. The restrooms for the use of children were observed by LPA in safe, sanitary, and operating condition. LPA notes parents provide lunches & snacks for children in care. Facility Representative informed LPA that filtered drinking water is available for consumption by preschoolers in care, and that children in care bring their own refillable water bottles from home.

LPA notes the CCC outdoor play area is fully enclosed. LPA notes the outdoor play areas for infants/toddlers (facility license # 566216107) and preschoolers are physically separated. LPA observed the entry/exit points to be secured. The footing in the outdoor play area is varied and features adequate cushioning to absorb falls. LPA notes an abundance of shade is available in the outdoor play area, provided by sun sails and the building structure. LPA observed age-appropriate toys & play equipment in the outdoor play area. The play equipment is free of sharp, loose or pointed objects. LPA reminded Facility Representative that outdoor play equipment and furnishings should be replaced when such items begin to degrade or are no longer in good repair. No bodies of water were observed on site.

LPA reviewed a sampling of children’s records. At 11:45AM, during records review, LPA determined that the LIC701 was not on file for Child #01 (C1), C2, C4, & C5, and that immunization records were not on file for C1 & C2. Through discussion with LPA, Facility Representative confirmed their understanding that the necessary medical assessment be obtained prior to or within 30 calendar days following the enrollment of a child, and that immunization documents be maintained in the center as long as the child is enrolled. Children's records reviewed were found otherwise to be current & complete. LPA reviewed a sampling of staff records for staff members present during the inspection, which were found current & complete as well, including AB1207 compliant mandated reporter training certification, as well as EMSA approved pediatric 1st aid & CPR training certification, among other required documents. The CCC maintains a current facility roster listing children in care. No firearms or ammunition are stored on site.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

(Cont. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC809 (FAS) - (06/04)
Page: 6 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216029
VISIT DATE: 07/08/2026
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

• CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES

LPA discussed the safe sleep regulations with facility representative 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 facility representative of the importance of checking for and removing any 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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. (Cont. 809-C, Page 4)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216029
VISIT DATE: 07/08/2026
NARRATIVE
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Two (2) Type B deficiencies were issued during today’s inspection pursuant to Title 22 of the California Code of Regulations (See LIC809-D). Facility Representative was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative, Judith Delarosa.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9