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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209816
Report Date: 10/14/2024
Date Signed: 10/14/2024 01:10:14 PM

Document Has Been Signed on 10/14/2024 01:10 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 CCCFACILITY NUMBER:
406209816
ADMINISTRATOR/
DIRECTOR:		ROSA AVILAFACILITY TYPE:
850
ADDRESS:525 NORTH THOMPSON AVENUETELEPHONE:
(805) 929-0016
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 14DATE:
10/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Rosa AilaTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 10/14/2024 at 12:00 PM, Licensing Program Analyst, (LPA) Gigi Reyes conducted an unannounced Case Management Inspection at the above Childcare Center. LPA met with Site Supervisor, Ms. Rosa Avila and explained the nature of the inspection. LPA arrived at the facility during nap time, there were 7 toddlers, and 7 preschoolers present under the Migrant Program, the Regional/regular season program is closed for in service staff training. There were 9 teachers present.

On October 7, 2024, at 3:20 PM an incident occurred involving Child # 1 ( C1), While walking around at the outdoor play area, Child #1 (C1) tripped on own C1's own shoe and fell. Child 1’s forehead struck a nearby table (children’s table), causing an open wound approximately size of a penny.

There were 2 teachers who witnessed the incident, and 2 children present including Child # 1 in the day care at the time of the incident. Immediate actions were taken by Staff members. Staff members provided comfort to the child and cleaned the wounded area of the forehead. The child’s mother was also notified who promptly took the child to the doctor for medical attention. Child’s wound was treated with a medical glue to close it.

Per Site Supervisor, the child returned today, October 14, 2024, because the mother preferred to keep the child at home to prevent the glued wound from getting wet as advised by the physician.

During today’s inspection, no deficiency was cited.

Exit interview conducted and report was reviewed with Site Supervisor, Ms. Rosa Avila.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
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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