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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712022
Report Date: 11/04/2021
Date Signed: 11/04/2021 12:30:51 PM

Document Has Been Signed on 11/04/2021 12:30 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:CAC - CUYAMA CENTERFACILITY NUMBER:
421712022
ADMINISTRATOR:KIM EICHERTFACILITY TYPE:
850
ADDRESS:2300 HIGHWAY 166TELEPHONE:
(661) 522-8813
CITY:CUYAMASTATE: CAZIP CODE:
93254
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 11DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Bertha Zendejas de GodoyTIME COMPLETED:
12:45 PM
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On 11/4/21, at 8:45 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required inspection the abovementioned Child Care Center (CCC). LPA met with Bertha Zendejas de Godoy, Site Supervisor of the CCC and explained the purpose of the inspection. LPA, in the company of the Site Supervisor, toured the interior and exterior of the CCC. The CCC operates out of a single classroom (#5) on the grounds of Cuyama Elementary School. The CCC's hours of operation are from 8:00 AM to 2:30 PM, Monday - Friday. During the inspection, LPA observed 11 children on site along with two teachers (cleared and associated) providing supervision.

The classroom of the CCC is organized and clean. The classroom has storage space afforded to each child in care. The classroom has age appropriate furnishings for children in care. The classroom has an operable refrigerator which contains food items consumed by the CCC's children. The CCC provided snacks, breakfast and lunch to children in care. There is available drinking water for children inside and outside. LPA observed a menu posted near the entry of the CCC. Additionally, LPA observed required notices and documents posted on the classroom's wall near the entry. LPA reviewed children's In/Out forms and found that the documents were completed sufficiently.

LPA observed an operable carbon monoxide detector on the wall of the classroom. The detector was tested at 9:30 AM and found to be operable. Disinfectants and cleaning solutions are stored in an elevated cabinet in the CCC. Sharps are observed secured in an elevated cabinet near the teacher's desk. Medications is secured near the teachers desks.Locations for cleaning products, sharps and medication are all inaccessible to children.
The three restrooms of the CCC are on the elementary school grounds Children in care are escorted to the restroom and staff members stay in proximity of the restrooms when in use. LPA observed the restrooms to be in sanitary operating condition.
(CONT. 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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 - CUYAMA CENTER
FACILITY NUMBER: 421712022
VISIT DATE: 11/04/2021
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The outdoor playground area is enclosed by chain link fencing. The fence’s entry/exit gates are secured and furnishings in the area are age appropriate. The play structures in the outdoor play area have adequate cushioning materials (i.e sand) to absorb falls. Shade is provided by trees in the area as well as building overhangs,. No bodies of water are observed on site.

Staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as medical assessments. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA) along with Mandated Reporter certifications. The Site Supervisor notes no firearm or ammunition is stored on site

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

Facility representative 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 conducted and report was reviewed with the Facility representative Bertha Zendejas de Godoy.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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