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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710581
Report Date: 08/08/2024
Date Signed: 08/08/2024 11:21:53 AM


Document Has Been Signed on 08/08/2024 11:21 AM - 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: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: 0DATE:
08/08/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Michelle RolleTIME COMPLETED:
12:00 PM
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On 8/8/24, at 11:15 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection (Licensee Initiated) of the abovementioned Child Care Center (CCC) as the CCC is requesting permission to relocate to another room within the same property/elementary school. LPA note the CCC operates out of a classroom on the grounds of Hawthorne Elementary School. LPA met with Michelle Rolle, Administrator of the CCC, and explained nature and purpose of the inspection. LPA notes no children are present during today's inspection.

LPA, in the company of Administrator, toured the interior and exterior of the CCC, as well as the proposed relocation room. The proposed relocation room, Multipurpose Room, is also on the grounds of Hawthorne Elementary School. The CCC planned to relocate to Multipurpose Room for the fall of 2024 school year which is set to commence on 8/15/24.

LPA observed the Multipurpose Room to have three exits and accommodations to support child care services. The Multipurpose Room has running water just outside of the entry/exit doors, as well as an operable carbon monoxide detector. The Multipurpose Room has centralized air conditioning. Age appropriate furnishing and equipment are being moving into the Multipurpose Room for the CCC's existing location. The CCC will use the existing restrooms for children in care, which are just outside of the Multipurpose Room. The CCC will also use the existing outdoor play area. Administrator is reminded to ensure children in care are not accessing play structures which are not age appropriate.

The Multipurpose Room is larger in scale than the existing room used for child care services. As such, the Multipurpose Room is feasible to support child care service. The CCC is granted permission to relocation to Multipurpose Room at the commencement of the 2024 Fall school year (8/15/24).

No deficiencies have been cited during today's visit. A Notice of Site Visit (LIC 9213) and Appeal Rights (CONT. 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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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: 08/08/2024
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(LIC 9058) are given to Administrator. The Notice of Site Visit must remain posted for 30 days or a civil
penalty of $100 may apply.

Exit interview conducted and report was reviewed with the Facility representative, Michelle Rolle.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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