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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700014
Report Date: 10/02/2024
Date Signed: 10/02/2024 02:03:09 PM


Document Has Been Signed on 10/02/2024 02:03 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CAPSLO - ATASCADERO HEAD STARTFACILITY NUMBER:
401700014
ADMINISTRATOR:KAREN EASTONFACILITY TYPE:
850
ADDRESS:965 EL CAMINO REALTELEPHONE:
(805) 466-2190
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:40CENSUS: 15DATE:
10/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Karen EastonTIME COMPLETED:
02:15 PM
NARRATIVE
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On 10/2/24, at 10:31 AM, Licensing Program Analysts (LPAs) Shane Loftus and Elvin Baddley conducted an unannounced Annual/Random Inspection of the facility. LPAs met with site supervisor Karen Easton and explained the purpose of the inspection. LPAs in the company of site supervisor, toured the interior and exterior of the Child Care Center (CCC). The CCC uses the main classroom, children’s bathroom, and outdoor play area for child care. The center operates from 7:30 AM to 4:30 PM, Monday through Friday. There were 4 teachers and 15 children in care at the time of the inspection.

LPAs observed required licensing documents mounted on the wall at the entrance of the facility. The CCC provides breakfast, lunch, and snacks for children in care. LPAs inspected the kitchen which was found to be clean and orderly. Sharp objects, cleaning compounds, and medications were found in locations to be accessible to teachers and staff, but inaccessible to children in care. LPAs inspected the children’s bathroom and found it to be clean and orderly. The carbon monoxide detector was tested at 10:35 AM and found to be functional. Facility has an ample number of cots available for children in care. The CCC offers filtered water for children in care. 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 child care 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). LPAs verified that the lead testing was completed in accordance with the Written Directives outlined.

The outdoor area is enclosed with chain link fencing and exit/entry gates are secured. Toys and play equipment observed by the LPAs are in suitable condition and free of sharp, loose, or pointed objects. The playground areas also have ample cushioning materials to absorb falls and an abundance of shade created by trees, and umbrellas. LPAs observed a secured shed in the playground area which contain CCC supplies. There are no bodies of water on the property.

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SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
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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Document Has Been Signed on 10/02/2024 02:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, staff did not comply with the section cited above in that S1 and S2 did not have current Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2024
Plan of Correction
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S1 and S2 will submit proof via email of completed Mandated Reporter Training to CCLD (shane.loftus@dss.ca.gov) no later than end of business on 10/16/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014
VISIT DATE: 10/02/2024
NARRATIVE
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A sampling of the children's records was reviewed and found to have the appropriate documents including Emergency Contact Information and Immunization Records. The staff’s records were reviewed. At 12:30 PM, LPAs reviewed Mandated Reporter training and notes S1 and S2 to not have current certifications. LPAs reminded site supervisor to ensure trainings and certifications are current. LPAs reviewed emergency drill log and observed the last emergency drill was conducted and documented within the last 6 months.

This facility provides Incidental Medical Services – IMS. LPAs 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 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.

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

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.

Continued on 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAPSLO - ATASCADERO HEAD START
FACILITY NUMBER: 401700014
VISIT DATE: 10/02/2024
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A Type B Deficiency is being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC 1596.8662(b)(1) (refer to LIC 809-D). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site supervisor, Karen Easton.

LPAs observed site supervisor posted the Notice of Site Visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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