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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215336
Report Date: 11/12/2021
Date Signed: 11/12/2021 03:50:12 PM

Document Has Been Signed on 11/12/2021 03:50 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:FUSD - SAN CAYETANO PRE SCHOOLFACILITY NUMBER:
566215336
ADMINISTRATOR:ELVIA PARREIRAFACILITY TYPE:
850
ADDRESS:514 MOUNTAIN VIEW ST.TELEPHONE:
(805) 524-6040
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
11/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Lorena RamosTIME COMPLETED:
02:20 PM
NARRATIVE
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On November 12, 2021 at 11:16 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Michael Mathew conducted an unannounced Annual/Random inspection. LPAs met with facility Site Supervisor Maria Barajas and advised her the purpose of the inspection. Site Supervisor provided LPAs a tour of the facility inside and out. There were 17 children in care at the time of the inspection.

The facility is located on a local school grounds. LPAs observed required licensing documents mounted on the wall in the classroom. The school provides snacks and lunch for the children in care. The center is using one (1) classroom for children in care. The facility has enough restrooms available for children in care. LPAs did not observe any hazards/toxins items accessible to children in care. Each of the classrooms have age appropriate toys and furniture readily accessible for children in care. Facility provides children that are staying full day a sleeping cot during quiet time if they choose to sleep. The outdoor playground has an ample amount of space for children to play. The playground has ample amount of shade available. The facility has water available for children inside and out. LPAs observed where children medications are stored and secured preventing children from having access. LPAs observed children and staff wearing face masks.

Staff records were reviewed. LPAs observed staff files to be complete and current. Teachers meet the required qualifications. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. LPA spoke with Director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines.

On November 12, 2021 at 1:10 PM, LPAs observed that the facility did not have children files available for the children enrolled in the classroom at the time of the inspection.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2021
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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Document Has Been Signed on 11/12/2021 03:50 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 11/12/2021 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER: 566215336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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Director advised that she must submit a written plan of correction to Community Care Licensing (CCL) by 11/23/21 stating what measures to be taken in order to follow Title 22 Regulations to prevent incidents like this happening again. Director advised she can provide the statement via email, fax, or mail.
Type B
Section Cited
CCR
101220.1(a)
Immunizations
(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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Director advised that she must submit a written plan of correction to Community Care Licensing (CCL) by 11/23/21 stating what measures to be taken in order to follow Title 22 Regulations to prevent incidents like this happening again. Director advised she can provide the statement via email, fax, or mail.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2021


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Document Has Been Signed on 11/12/2021 03:50 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 11/12/2021 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER: 566215336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. (1) This requirement includes updating each child's immunization record when the child is due to receive required immunizations after enrollment in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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Director advised that she must submit a written plan of correction to Community Care Licensing (CCL) by 11/23/21 stating what measures to be taken in order to follow Title 22 Regulations to prevent incidents like this happening again. Director advised she can provide the statement via email, fax, or mail.
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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Director advised that she must submit a written plan of correction to Community Care Licensing (CCL) by 11/23/21 stating what measures to be taken in order to follow Title 22 Regulations to prevent incidents like this happening again. Director advised she can provide the statement via email, fax, or mail.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2021


LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 11/12/2021 03:50 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 11/12/2021 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER: 566215336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)
Child's Records
(b) Each record shall contain information including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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2
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Director advised that she must submit a written plan of correction to Community Care Licensing (CCL) by 11/23/21 stating what measures to be taken in order to follow Title 22 Regulations to prevent incidents like this happening again. Director advised she can provide the statement via email, fax, or mail.
Type B
Section Cited
CCR
101221(d)
Child's Records
(d) All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/23/2021
Plan of Correction
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 17 out of 17 children which poses/posed a potential health, safety or personal rights risk to persons in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2021


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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: FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER: 566215336
VISIT DATE: 11/12/2021
NARRATIVE
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LPAs advised Director Lorena Ramos that every child must have a facility file at all times. Director was advised that the facility is currently out of regulation by not having files at the facility for children enrolled. Director advised that she understood children files are required to be available. Director advised they are in process of getting files for each child. The following CCR, Title 22, Division 12 regulations were cited: 101220(a) Children Medical Assessments, 101220.1(a) Immunizations, 101220.1(g)(1) Immunizations, 101221(a) Children's Records, 101221 (b) Children's Records, and 101221(d) Children's Records..

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 follow 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

There was six (6) type B deficiencies cited during today's inspection.

Director was provided and advised of their right to appeal.

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.

Director 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 Director
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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