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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401711512
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:17:46 PM

Document Has Been Signed on 02/01/2024 03:17 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:CAPSLO - PASO ROBLES HEAD STARTFACILITY NUMBER:
401711512
ADMINISTRATOR:BRANDY BLACKBURN-HERNDONFACILITY TYPE:
850
ADDRESS:304-19TH STREETTELEPHONE:
(805) 238-5323
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 56TOTAL ENROLLED CHILDREN: 44CENSUS: 14DATE:
02/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Brandy Blackburn-HerndonTIME COMPLETED:
03:30 PM
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On 2/01/2024, Licensing Program Analysts (LPAs) Martina Jimenez, and Joaquin Mendez conducted an unannounced Case Management inspection to follow up on a report of an Unusual Incident Report (UIR) received by the Department on 1/11/2024.

LPAs met with Brandy Blackburn-Herndon, Site Supervisor, the purpose of the inspection was discussed. LPA tour the center with the Site Supervisor, LPA observed 14 children in care and 3 staff at the time of inspection.

LPAs spoke with Vianey Gonzalez Montoya, Associate Teacher, in reference to the incident that occurred on 1/11/2024. The incident was found to have been appropriately handled by the center. The center will continue to monitor the children's behavior encourage safe play and go over safety rules throughout, the day, talking with staff, and children on safety play.

Based on observations and the interview with the Site Supervisor. It is determined by LPA to be best categorized the incident as an accident.

There were no deficiencies cites at this time. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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