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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209167
Report Date: 12/04/2024
Date Signed: 12/04/2024 10:23:12 AM

Document Has Been Signed on 12/04/2024 10:23 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PACHECO ELEMENTARYFACILITY NUMBER:
406209167
ADMINISTRATOR/
DIRECTOR:		HANNAH KONDRATKOFACILITY TYPE:
840
ADDRESS:261 CUESTA DRIVETELEPHONE:
(805) 781-7447
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Michelle Rolle TIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 12/4/24, at 8:50 AM, Licensing Program Analyst (LPA) Shane Loftus conducted an unannounced Annual Random inspection of the Child Care Center (CCC). LPA met with Michelle Rolle, Administrator of the CCC and explained the purpose of the inspection. LPA, in the company of the Administrator, toured the interior and exterior of the CCC. The CCC is located in classroom (Room 14) on the grounds of Pacheco Elementary School. The CCC operates from 7:00 AM to 6:00 PM, Monday through Friday. The CCC has an AM program on site from 7:00 AM to 8:15 AM and a PM program on site from 2:40 PM to 6:00 PM. It should be noted there were 0 children and 2 teachers (cleared and associated) present during the inspection.

The CCC classroom has age appropriate equipment and furnishings available to children in care. LPA observed a carbon monoxide detector in the CCC which was tested at 9:15 AM and found to be operable. The restrooms used by the children (inside the classroom and on the grounds of the elementary school) are in safe and sanitary operating condition. LPA observed an operable refrigerator in the classroom room which contains food for the children. The CCC provides a mid-day snacks for the children and LPA observed a CCC menu posted. Disinfectants, cleaning solutions, medications and sharps are locked in a cabinet in the classroom which is inaccessible to children in care and secured. Children have available drinking water inside of the CCC and out. The water source comes from building fountains.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Continued on 809-C
Maria MuellerTELEPHONE: (805) 562-0400
Shane LoftusTELEPHONE: (805) 562-0400
DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PACHECO ELEMENTARY
FACILITY NUMBER: 406209167
VISIT DATE: 12/04/2024
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LPA reviewed the CCC's Sign In/Out forms for children and notes the forms contain the children's arrival and departure times as well as the signature of the children's authorized representatives. LPA observed required licensing notices and documents posted on the wall near the teacher's desk.

The CCC's outdoor playground area is enclosed by fencing. The surface in the area is varied. LPA observed fence’s entry/exit gates are secured. LPA observed age-appropriate play equipment in the play area. The play equipment is free of sharp, loose or pointed objects. The play structures in the playground area have adequate cushioning materials to absorb falls. LPA noted a shed is also in the outdoor play area which is secure and contains Elementary school and CCC supplies. No bodies of water are observed on site. LPA notes the outdoor play area is shared with the Elementary school's kindergarten classrooms. Administrator informed LPA the CCC's children are present in the play area at different times (staggered) than the elementary school students.

A sampling of staff and children's records were reviewed. The children’s records are complete and found to contain emergency contact information and admission agreements. Staff records were reviewed and contained documentation to support their educational training and experience. LPA also observed current Pediatric CPR/ First Aid (EMSA approved) certifications along with Mandated Reporter training certifications. LPA reminded Administrator to ensure training certification are current and renewed prior to expirations. Administrator noted no firearm or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PACHECO ELEMENTARY
FACILITY NUMBER: 406209167
VISIT DATE: 12/04/2024
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Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiencies were cited during today's inspection. 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 Michelle Rolle.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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