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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209816
Report Date: 03/14/2022
Date Signed: 03/14/2022 01:01:52 PM

Document Has Been Signed on 03/14/2022 01:01 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-WILLIAM "BILL" CASTELLANOS MSHSFACILITY NUMBER:
406209816
ADMINISTRATOR:W. CASTELLANOS - T5FACILITY TYPE:
850
ADDRESS:525 NORTH THOMPSON AVENUETELEPHONE:
(805) 929-0016
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 4DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rosa AvilaTIME COMPLETED:
01:00 PM
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On March 14, 2022 at 9:15 AM, Licensing Program Analyst (LPA) GIgi Reyes conducted an unannounced Required 1- Year Inspection and met with Site Supervisors, Rosa Avila and Francisca Osuna. LPA asked pre screening questions related to COVID -19 and Site Supervisor responses indicates there are no COVID 19 exposures on site. LPA discussed the purpose of the inspection. There were 4 children and 3 staff present under the Regular Class Program. Migrant Seasonal Program will resume its operation on April 5, 2022.

LPA together with Site Supervisor Rosa Avila toured the Child Care Center (CCC) Facility. LPA observed Licensing required forms were posted by the courtyard entrance. There are 3 classrooms used by the Center, Room nos. 002, 004, 007. The classrooms are equipped with age appropriate games, activities, and furniture available for children in care. LPA observe and reviewed the posted menu. The center provides breakfast, lunch and snack. Water jug dispenser supplies the drinking water inside and outside the classroom. The outdoor playground is completely fenced with age appropriate toys and equipment. The playground has an ample amount of shade available and cushioning under the play equipment.

CCC sign-in/sign out log is complete. A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have current Pediatric First Aid/CPR certificates that expire 6/5/2023. Teachers have current AB 1207 Mandated Reporter Training certificates that expire on 3/10/2024. Teachers required immunization per SB 792. . CCC is implementing the COVID 19 Guidelines. CCC conducts fire and disaster drill every month. CCC toddler option physically checks and documents condition of napping children every 15 minutes.

No deficiencies were cited during today's visit.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAPSLO-WILLIAM "BILL" CASTELLANOS MSHS
FACILITY NUMBER: 406209816
VISIT DATE: 03/14/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 inspectionprocess@dss.ca.gov. 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/process.

Site Supervisors were reminded that all adults 18 and over, 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 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.

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
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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