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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710581
Report Date: 10/26/2021
Date Signed: 10/26/2021 03:15:35 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:HAWTHORNE ELEMENTARY SCHOOLFACILITY NUMBER:
401710581
ADMINISTRATOR:MICHELLE ROLLEFACILITY TYPE:
840
ADDRESS:2125 STORYTELEPHONE:
(805) 781-7447
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:55CENSUS: 32DATE:
10/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Emily ScarboroughTIME COMPLETED:
03:30 PM
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On 10/26/21, at 1:00 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Inspection of the abovementioned Child Care Center (CCC). LPA met with Director Emily Scarborogh and explained the purpose of the inspection. LPA, in the company the Director toured the interior and exterior of the CCC. The CCC operates on the grounds of Hawthorne Elementary School from 7:00 AM to 6:00 PM, Monday - Friday. The CCC uses one classroom for care. LPA observed 32 children on site along with 2 teachers providing care and supervision.

The classroom of the CCC is clean and organized. The classroom has age appropriate furnishings available for children. LPA observed a carbon monoxide detector near the entry of the CCC which was tested at 1:30 PM and found to be operable. The attached restroom is in safe and sanitary operating conditions. The restroom contains a single toilet and a sink just outside of the restroom. Children also have access to two restroom at the school site. Children are escorted to the restroom by staff members who remain in proximity of the restroom area during use.

Disinfectants, cleaning solutions and medication are stored on elevated shelves in a locked cabinet. The cabinet is inaccessible to children in care. Sharps in the CCC are stored in the drawer of the teacher desk which is secure and inaccessible to children.

The CCC provides snacks for the children, while lunches are provided by the elementary school. Children have access to water both inside of the classroom and outside in the activity area. LPA observed a posted menu near the entry of the CCC. Likewise, the classroom has licensing required notices posted predominately near the teacher's desk. The LPA reviewed the CCC's Sign In/Out forms which were completed appropriately.

The CCC's outdoor playground area is comprised of a grass lawn, black top surfaces and a wood chip play
CONT. 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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: HAWTHORNE ELEMENTARY SCHOOL
FACILITY NUMBER: 401710581
VISIT DATE: 10/26/2021
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box. The playground area is enclosed by chain linked fencing. LPA observed age appropriate furnishing in the area. The play structure in the playground area has adequate cushioning materials (i.e. wood chips) to absorb falls and an abundance of shade created by trees and building overhangs. No bodies of water are observed on site. LPA observed waste receptacles with tight fitting covers throughout the CCC.

Staff and children's records were reviewed. The children’s records were complete and found to contain emergency contact information. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA) along with Mandated Reporter certifications. The Director noted no firearm or ammunition is stored on site

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: 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 Emily Scarborough.



SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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