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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208270
Report Date: 01/23/2024
Date Signed: 01/23/2024 03:28:33 PM


Document Has Been Signed on 01/23/2024 03:28 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 - SANTA ROSA EARLY EDUCATION & CHILD CAREFACILITY NUMBER:
406208270
ADMINISTRATOR:A. RAMIREZ-BARRONFACILITY TYPE:
850
ADDRESS:864 SANTA ROSATELEPHONE:
(805) 594-1752
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:17CENSUS: 14DATE:
01/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Wendy VillabaTIME COMPLETED:
01:31 PM
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On 1/23/2024, Licensing Program Analyst (LPA) Martina Jimenez, conducted an unannounced Case Management inspection to follow up on a report of an Unusual Incident Report (UIR) that was self-reported to the department on 1/17/2024.

LPA met with Wendy Villaba, Lead Teacher, the purpose of the inspection was discussed. LPA with lead teacher tour the interior & exterior of the center. LPA observed 14 children in care and 3 staff at the time of inspection. The Site Supervisor, Megan-Noelle Larkin, arrive to the center at 1:03pm, during the inspection.

LPA interviewed the staff, in reference to the incident that occurred on 1/17/2024. The incident was found to have been appropriately handled by the center. The center will continue to follow protocol and inspection the play ground for debris, unusual items, and foreign objects in and around the children's play areas throughout the day, talking with staff, and children on safety play.

Based on observations and the interviews with staff it is determined by LPA to be best categorized the incident as an accident.

LPA obtained a copy of the children's roster. No citations were issued during this inspection. LPA observed Licensee post the Notice of Site visit
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024
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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