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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406206384
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:18:46 AM

Document Has Been Signed on 04/18/2024 10:18 AM - 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 - STEP BY STEP EARLY HEAD STARTFACILITY NUMBER:
406206384
ADMINISTRATOR/
DIRECTOR:
A. RAMIREZ-BARRONFACILITY TYPE:
830
ADDRESS:1055 MESA VIEW DRIVETELEPHONE:
(805) 474-3750
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 10DATE:
04/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Ruby AlcantarTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 4/18/24, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) to address an incident report received by CCLD on 4/9/24. Specifically, C1 was on play structure in the outdoor area. C1 lost balance while going down the ramp/slid and hit the back of the head causing a bump on the back of C1's head.

Site Supervisor provided LPA an account of what transpired and re-enacted the incident. LPA observed the play structure which was structurally sound and age appropriate. LPA asked Site Supervisor if C1 is on site. Site Supervisor affirmed C1 is present and directed LPA to C1's attention. LPA noted C1 appeared in good health and had no lasting injuries from the incident.

It is the opinion of the LPA the incident was accidental and neither the staff members nor the facility's equipment contributed to the incident.

No deficiencies were cited during today's inspection.



A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements may result in a civil penalty of $100.

Exit interview conducted and report was reviewed with Site Supervisor Ruby Alcantar.


SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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