406213418-12-2-2022-17-CC-EBAY-CLQUYX-20221202150041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406213418
Report Date: 12/02/2022
Date Signed: 12/02/2022 03:01:03 PM

Document Has Been Signed on 12/02/2022 03:01 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 - CUESTA HEAD START - RM 4011		FACILITY NUMBER:	406213418
ADMINISTRATOR:	ADRIANA BARRON		FACILITY TYPE:	850
ADDRESS:	4000 CHORRO VALLEY RD.		TELEPHONE:	(805) 546-3100
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93405
CAPACITY:	20	CENSUS: 12	DATE:	12/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Penny Glass		TIME COMPLETED:	01:30 PM

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	On 12/2/22, at 11:16 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required inspection of the abovementioned Child Care Center (CCC). The LPA met with Penny Glass, 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 on the grounds of Cuesta College's Children's Center Room 4011 from 8:00 AM to 4:30 PM, Monday - Friday. At the time of the inspection, LPA observed 12 children present, along with 3 teachers (cleared and associated) proving care and supervision. The CCC is clean and organized. LPA observed age appropriate toys and furnishings throughout the CCC. LPA observed a carbon monoxide detector in the CCC which was tested at 11:40 AM and found to be operable. The CCC's bathroom is in sanitary operating condition. The CCC has an operable refrigerator and LPA notes the CCC provides snacks, breakfast and lunches for children in care. LPA observed a facility menu posted along with required licensing forms, documents and notices. The CCC provides the children in care bottled/filtered water both inside the facility and in the outdoor activity area. Site Supervisor informed LPA the CCC's water sources have been tested for lead containments. Disinfectants and cleaning solutions are stored in secure cabinets in the classroom. Additionally, medication in the facility is stored in a secure elevated location in the CCC which is beyond the reach of children in care. LPA observed Sign In/Out forms on a clipboard near the CCC's entry. LPA notes the forms contain the child's arrival and departures as well as the signature of the authorized representatives. The CCC's outdoor play area has varied footing and is enclosed by chain link fencing. Entry/exit gates are secured. LPA observed sheds (two) 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. LPA reminded Site Supervisor to have toys and play equipment, both inside and outside replaced when such items begin to degrade or are not in good repair. Play structure have adequate cushion to absorb for falls. LPA observed no bodies of water (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: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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: 12/02/2022

NARRATIVE

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on site.

A sampling of staff and children's records were reviewed. The children’s records were complete and found to contain emergency contact information as well as immunization records. Staff records were reviewed and current with Pediatric First Aid/CPR (EMSA Approved) and Mandated Reporter Training certifications, as well as documentation supporting qualifications and experience. Site Supervisor informed LPA no firearms are 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.

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 Penny Glass.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

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