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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700014
Report Date: 11/01/2024
Date Signed: 11/01/2024 12:04:17 PM

Document Has Been Signed on 11/01/2024 12:04 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:CAPSLO - ATASCADERO HEAD STARTFACILITY NUMBER:
401700014
ADMINISTRATOR/
DIRECTOR:		KAREN EASTONFACILITY TYPE:
850
ADDRESS:965 EL CAMINO REALTELEPHONE:
(805) 466-2190
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 13DATE:
11/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:16 AM
MET WITH:Karen EastonTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 11/1/24, at 11:16 AM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Case Management inspection at the abovementioned Child Care Center (CCC). LPA met with Karen Easton, Site Supervisor of the CCC and explained the nature/purpose of the inspection. LPA, in the company of the Site Supervisor toured the interior and exterior of the CCC. LPA notes 13 children are in care, along with 3 teachers providing care and supervision.

The Case Management inspection follows an Unusual Incident at the CCC which occurred on or about 9/24/24. During this instance, a child in care (C1), and the child's parent informed a facility staff member (S1) the facility's Site Supervisor had inappropriately handled C1. The parent of C1 reportedly advised S1 C1 had new bruises and a small bloody spot on knee area.

During an interview of S1 on 10/2/24, S1 acknowledged receiving information pertaining to C1 being inappropriately handled, however S1 informed LPA S1 did not report the statements of C1 and C1's parent to the facility's Superior, CCLD or the local Child Welfare Service agency (San Luis Obispo County Social Services Department). At the time of the interview, LPA reminded S1, as a Mandated Reporter, there is an obligation to report instances of suspected child abuse when received pursuant to regulation (CCR 101212).

A Type B Deficiency are being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Site Supervisor was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.



An exit interview was conducted with Facility Representative Karen Easton. Facility Representative was provided with a Notice of Site Visit (LIC 9213). Notice of Site Visit must be posted for 30 days or a civil penalty of $100 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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Document Has Been Signed on 11/01/2024 12:04 PM - It Cannot Be Edited


Created By: Elvin Baddley On 11/01/2024 at 11:26 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: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
Section Cited
CCR
101212(d)(1)(D)

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department...(1) Events reported shall include the following: (D) Any suspected physical or psychological abuse of any child. This requirement was not met
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Licensee to submit an outline to CCLD (elvin.baddley@dss.ca.gov) by the close of business (5:00 PM) 11/15/24, making mention of how CCC staff will ensure instances of actual or suspected child abuse will be reported in accordance to CCR 101212.
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as evidenced by: Based on observation/interview/record review, S1 did not report an incident of suspected child abuse when appraised of the suspected child abuse to C1 on or about 9/24/24, which poses a potential health, safety or personal rights risk to persons 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:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


LIC809 (FAS) - (06/04)
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