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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421709731
Report Date: 09/26/2022
Date Signed: 10/04/2022 10:36:57 AM

Document Has Been Signed on 10/04/2022 10:36 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:CAC - GUADALUPE CENTERFACILITY NUMBER:
421709731
ADMINISTRATOR:ELVA QUINTANILLAFACILITY TYPE:
850
ADDRESS:130 TOGNAZZINI AVETELEPHONE:
(805) 343-5598
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY: 25TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elva QuintanillaTIME COMPLETED:
10:40 AM
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This is an Amended Report for the inspection conducted on September 26, 2022.


On September 26 , 2022 @ 12:05 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an announced Inspection for the purpose of performing a pre-licensing inspection. LPA asked Applicant Pre- Screening questions related to COVID-19. Applicant's responses to the Pre-screening questions suggest no COVID-19 exposure on site.

Licensing Program Analyst (LPA) Martina Jimenez made an unannounced inspection to the facility for the purpose of conducting a Required -1 year inspection. LPA met with Elva Quintanilla, Site Supervisor, and explained the purpose of the inspection. The facility operates Monday - Friday 6:30 AM - 5:00 PM. There were 9 children present at the time of the inspection.

LPA together with the Site Supervisor tour of the facility inside and outside. The classroom was observed to have age appropriate furniture/equipment. The restroom was observed to be clean and free of toxins. There is a functioning smoke/carbon monoxide detector in the classroom. All required State forms and daily menu were posted. The outdoor play area is completely fenced. LPA observed age appropriate equipment and cushioning. Drinking water is available inside and outside.

Teacher files reviewed and were found to be complete. At least one teacher in each classroom has valid Pediatric CPR/First Aid which expires on 8/27/2024. Center staff have completed AB1207 Mandated Reporter Training. Sign in and sign out verified and matched census. Children's files were reviewed and found to be complete.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free

This Report Continues on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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: CAC - GUADALUPE CENTER
FACILITY NUMBER: 421709731
VISIT DATE: 09/26/2022
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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 Supervisor is reminded that they are responsible for knowing the regulations for a Child Care Center and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Site Supervisor, Effects of Lead Exposure Brochures

Site Supervisor was 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 was conducted and report was reviewed with the Site Supervisor, There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was posted in LPA's presence.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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