401710988-5-31-2023-17-CC-DMWT-CSCQJS-20230531121315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401710988
Report Date: 05/31/2023
Date Signed: 05/31/2023 12:13:23 PM

Document Has Been Signed on 05/31/2023 12:13 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CAPSLO - FIVE CITIES HEAD START		FACILITY NUMBER:	401710988
ADMINISTRATOR:	A. RAMIREZ-BARRON		FACILITY TYPE:	850
ADDRESS:	1800 WILMAR STREET		TELEPHONE:	(805) 473-1657
CITY:	OCEANO	STATE: CA	ZIP CODE:	93445
CAPACITY: 43	TOTAL ENROLLED CHILDREN: 43	CENSUS: 17	DATE:	05/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Candy Echeverria		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/31/2023 at 9:30 AM, Licensing Program Analysts (LPAs) Francisca Velazquez and Dixie Wright conducted an unannounced Required/One year inspection. LPAs met with facility Intern Center Supervisor Candy Echeverria and advised her the purpose of the inspection. There were 17 children in care at the time of the inspection. This center operates from 7:45 AM - 4:45 PM, Monday - Friday. This center is a pre-school only program. LPAs observed required licensing documents posted on the wall at the entrance of the facility. A snack/lunch schedule and menu was observed. The facility provides a morning and afternoon snack and lunch for children in care. Lunch and snacks are included in the program. Food was stored properly. The center is currently using the A side of the building only, the B side is closed temporarily. The program has two bathrooms with two toilets and a sink, each readily accessible to children in care. There is a locked restroom for staff. LPAs did not observe hazards/toxins accessible to children in care. LPAs observed the A and B side classrooms to have an ample amount of age-appropriate toys, books, and furniture readily accessible to children in care. LPAs observed and tested carbon monoxide detector at 10:10 AM and found it to be operable. The playground has an ample amount of shade. LPAs observed the playgrounds have age-appropriate toys and structures readily accessible for children in care. The facility ensures children have access to water by having a water service deliver and providing disposable cups. LPAs did not observe any bodies of water on site. Four sheds were observed in playgrounds, three were locked and one was empty and used as storage. A sampling of children files were reviewed and contained all required documents. Staff records were reviewed. LPAs observed staff files to be current and complete. SB792 Child Adult Immunization and Tuberculosis requirements are readily accessible for review. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAPSLO - FIVE CITIES HEAD START	FACILITY NUMBER: 401710988
	VISIT DATE: 05/31/2023

NARRATIVE

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The facility was tested for lead on 12/12/2022 by a certified Lead Inspector, and report dated 12/28/2022 shows the facility water is well below the action level of lead and water can be continued to be used.

Center staff CPR/First-Aid certificate expires on 08/11/2024. Supervisor's Mandated Reporter certificate expires on 12/12/2024. Per Supervisor, there are no guns or ammunition on site.

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

Supervisor was reminded that all adults 18 and working in the program, 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 Center. 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.

No deficiency cited during today's inspection. Appeal rights provided to Supervisor.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor, Candy Echeverria.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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