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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214424
Report Date: 07/17/2024
Date Signed: 07/17/2024 01:05:40 PM

Document Has Been Signed on 07/17/2024 01:05 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-NIPOMO HEAD STARTFACILITY NUMBER:
406214424
ADMINISTRATOR/
DIRECTOR:		A. RAMIREZ-BARRONFACILITY TYPE:
850
ADDRESS:291 THOMPSON ROADTELEPHONE:
(805) 544-4355
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 12DATE:
07/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Socorro CanoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On July 17, 2024, at 10:15 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual inspection at the above Child Care Center (CCC). The purpose of the inspection was discussed with Site Supervisor Socorro Cano who provided a tour of the facility. The inspection revealed the following findings:

During the tour LPA observed the following: There were 12 children in the playground supervised by 3 teachers. Following that LPA and Site Supervisor proceeded with the inspection of the classroom, it was observed that licensing-required notices are posted prominently at the entrance door. The current menu was also posted. The CCC utilizes a classroom, there were 2 toilet bowls, 2 sinks available for children. Age-appropriate games, activities, and furniture were available for children inside the classroom, and the outdoor playground had age-appropriate toys and equipment with ample shade. The CCC had water available for children inside and outside the classroom supplied by Arrow head water company.

A sampling of children and staff records were reviewed. Children’s files were found complete. Teachers present have current Pediatric First Aid/CPR certificate that expires on 2/13/2025. All staff members have renewed the Mandated Reporter Training which expires on 6/15/2025. Staff have complete Health Screening record on file including the tuberculosis clearance.

Continued on LIC 809 C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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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-NIPOMO HEAD START
FACILITY NUMBER: 406214424
VISIT DATE: 07/17/2024
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LPA verified SB 792 Child Care Adult Immunization and the educational qualification requirements.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.



Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
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-NIPOMO HEAD START
FACILITY NUMBER: 406214424
VISIT DATE: 07/17/2024
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This facility provides Incidental Medical Services (IMS). LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Site Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During today’s inspection, no deficiencies were cited under Title 22 Division 12.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor, Socorro Cano
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
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