<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700014
Report Date: 10/24/2019
Date Signed: 10/24/2019 03:40:01 PM

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 - ATASCADERO HEAD STARTFACILITY NUMBER:
401700014
ADMINISTRATOR:D. WELCH /K. EASTONFACILITY TYPE:
850
ADDRESS:965 EL CAMINO REALTELEPHONE:
(805) 466-0417
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:40CENSUS: 30DATE:
10/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Karen EastonTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(2) Licensing Program Analyst (LPA), Melissa Stewart, conducted an annual random inspection and met with Site Supervisors, Karen Easton and Susan Riojas. The center operates two programs in two buildings. The Full Day program is located in Building A and is open 7:30am - 5:15pm. The Extended Day program is located in Building B and operates 8:30am- 3:30pm. Total census at time of inspection was 30 children. LPA observed 14 children napping in Building A with three staff and 16 children in Building B with three staff. The center was toured inside and outside. All required forms, including menu, are posted at the main entrance of the buildings. The classrooms and restrooms used by children were observed to be clean, organized and free of toxins. LPA observed age appropriate toys, books, activity centers, cubbies and nap cots. The last fire drill was conducted on 9/30/19 and the most recent earthquake drill was conducted on 10/17/19. There are carbon monoxide detectors in both buildings. Site Supervisor reported that there are no firearms, ammunition or bodies of water on the premises. All hazardous items are inaccessible to children in care. LPA reviewed the first aid kit and medication which is maintained in the orange backpack hanging by the door to the outdoor play area. The outdoor play areas are completely fenced. LPA observed age appropriate toys, climbing structures with appropriate cushioning, shade and grass activity areas. Drinking water is available both inside and outside via water dispensers and disposable cups.

Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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 - ATASCADERO HEAD START
FACILITY NUMBER: 401700014
VISIT DATE: 10/24/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 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: www.ada.gov/childqanda.htm

A sample of staff files were reviewed. At least one teacher is current with CPR and First Aid which expires 1/9/21. Staff have completed the Mandated Reporter Training per AB 1207 and have met immunization requirements per SB 792. A sample of children's records were reviewed and found complete. Site Supervisor reported that the “Effects of Lead Exposure” brochure is distributed to all families at time of enrollment. Site Supervisor was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.


In areas evaluated, no deficiencies cited.

LPA observed Notice of Site Visit posted

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2