406203715-12-2-2019-17-CC-EBAY-BJGRKZ-20191202120624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406203715
Report Date: 12/02/2019
Date Signed: 12/02/2019 12:06:31 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 - SUNNYSIDE HEAD START		FACILITY NUMBER:	406203715
ADMINISTRATOR:	OSCAR RAMIREZ		FACILITY TYPE:	850
ADDRESS:	880 MANZANITA DRIVE		TELEPHONE:	(805) 528-1820
CITY:	LOS OSOS	STATE: CA	ZIP CODE:	93402
CAPACITY:	40	CENSUS: 27	DATE:	12/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Oscar Ramirez		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). LPA met with Oscar Ramirez ,site supervisor of the CCC and explained the purpose of the inspection. The LPA, in the company of the site supervisor, toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 4:30 PM, Monday - Friday. The CCC uses two classrooms for care ( preschool room and toddler A/B) and had a population of 27 children at the time of the inspection. The classrooms of the CCC were clean and organized. The classrooms had age appropriate toys and furnishings available for children. Each classroom had operable carbon monoxide detectors. The attached restrooms were in safe and sanitary operating condition. Each restroom had two toilets and sinks were located just outside of the restrooms . The attached kitchens were observed to be clean and free of litter. Food and beverages capable of spoiling were stored in an operable refrigerator. Disinfectants and cleaning solutions were locked underneath cabinets in the kitchen area and inaccessible to children. LPA observed the center’s medications secured in a lock box on an elevated shelf in the children's restroom. The CCC provides breakfast, lunch and mid day snack (between 2:30 PM - 3:30 PM). LPA reviewed posted menus as well as licensing required documentation. Sign In/Out form which were completed appropriately. The CCC's outdoor playground areas is enclosed by chain linked fencing. LPA observed age appropriate toys/play equipment in the play area. The toys/play equipment are in suitable condition and free of sharp, loose or pointed objects. The play structures in the playground areas have adequate cushioning materials (i.e. artificial grass padding) to absorb falls and a shaded covering. A sampling of staff and children records were reviewed. Children’s records were complete and found to contain emergency contact information as well as medical assessments. Staff records were reviewed and CONT .LIC 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019

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: CAPSLO - SUNNYSIDE HEAD START	FACILITY NUMBER: 406203715
	VISIT DATE: 12/02/2019

NARRATIVE

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contained health assessments. Site Supervisor noted no firearms/weapons or ammunition was stored on the premises.

LPA discussed a guide for Safe Sleep and the Effects of Lead Exposure with the site supervisor and provided supporting literature.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

In areas evaluated, no deficiencies observed.

LPA observed site supervisor post the Notice of Site visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019

LIC809 (FAS) - (06/04)

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