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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213418
Report Date: 12/13/2021
Date Signed: 12/13/2021 10:58:42 AM

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 - CUESTA HEAD START - RM 4011FACILITY NUMBER:
406213418
ADMINISTRATOR:ADRIANA BARRONFACILITY TYPE:
850
ADDRESS:4000 CHORRO VALLEY RD.TELEPHONE:
(805) 546-3100
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:20CENSUS: 4DATE:
12/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Allison FloodTIME COMPLETED:
11:00 AM
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On 12/13/21, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required inspection of the abovementioned Child Care Center (CCC). The LPA met with Allison Flood, Site Supervisor of the CCC and explained the purpose of the inspection. LPA, in the company of the Site Supervisor toured the interior and exterior of the CCC. The CCC operates from 8:00 AM to 4:30 PM, Monday - Friday. At the time of the inspection, four children are present, along with two teachers (cleared and associated) proving care and supervision.

The CCC is clean and organized. Likewise, the CCC has ventilation to afford for child care. LPA observed age appropriate toys and furnishings throughout the CCC. LPA observed a carbon monoxide detector which was tested at 9:10 AM and found to be operable. The CCC's bathroom is in safe and sanitary operating condition. The CCC has an operable refrigerator and LPA notes the CCC provides snacks and lunches for children in care. LPA observed a facility menu posted on the CCC wall. The CCC provides the children in care bottled/filtered water both inside the facility and in the outdoor activity area. Disinfectants and cleaning solutions are stored in secure cabinets in the classroom. Likewise, medication in the facility is stored in a secure elevated location which is beyond the reach of children in care.

LPA observed licensing required notices on the wall near the entry door of the CCC. LPA observed Sign In/Out forms on a clipboard near the CCC entry. LPA notes the forms contain the child's arrival and departure as well as the signature of the authorized representative/parent.

The center’s outdoor play area is enclosed chain link fencing. Entry/exit gates are secured. LPA observed sheds in the play area which were secure by lock and contained CCC supplies. LPA observed age appropriate toys/play equipment in the play areas. The toys/play equipment are free of sharp, loose or pointed objects. No bodies of water were observed on site. Play structure have adequate cushion to absorb for falls.
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
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 - CUESTA HEAD START - RM 4011
FACILITY NUMBER: 406213418
VISIT DATE: 12/13/2021
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Site Supervisor notes no firearms/weapons or ammunition was stored on the premises.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as medical assessments. Staff records were reviewed and contained pediatric CPR and First Aid certifications as well as Mandated Report certifications.


This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

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 Allison Flood.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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