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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213771
Report Date: 03/07/2022
Date Signed: 03/07/2022 01:02:01 PM


Document Has Been Signed on 03/07/2022 01:02 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:PACHECO ELEMENTARY SCHOOLFACILITY NUMBER:
406213771
ADMINISTRATOR:CARMEN WOODFACILITY TYPE:
850
ADDRESS:261 CUESTA DR.TELEPHONE:
(805) 596-4081
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:26CENSUS: DATE:
03/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica GarciaTIME COMPLETED:
01:00 PM
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On 3/7/22, at 9:45 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required inspection the abovementioned Child Care Center (CCC). LPA met with Monica Garcia, Director of the CCC and explained the purpose of the inspection. LPA, in the company of Director, toured the interior and exterior of the CCC. The CCC operates out of a single classroom on the grounds of Pacheco Elementary School. The CCC's hours of operation are 8:30 AM to 12:30 PM, Tuesday - Friday Monday 9:30 AM - 12:30 PM . During the inspection, LPA observed 18 children in care along with a teacher and a teacher assistant. It should be noted the Director also affords for the care and supervision of children on site.

The classroom of the CCC is clean and organized. The classroom has storage space afforded to each child in care. The classroom has age appropriate furnishings and equipment for children in care. The CCC provides lunches and a midmorning snack for children in care. There is available drinking water for children both inside and outside of the classroom. LPA observed a menu posted on the entry door of the CCC. Additionally, LPA observed required notices and documents posted on the classroom's cabinets near the entry. LPA reviewed children's Sign In/Out forms and found that the documents were completed appropriately.

LPA observed an operable carbon monoxide detector in the classroom. The detector was tested at 12:30 PM and found to be operable. Disinfectants and cleaning solutions are stored in the CCC's staff restroom which is inaccessible to children in care. Disinfectants and cleaning solutions are also on an elevated shelf in the classroom which is beyond the reach of children. Sharps are observed on an elevated shelf in a plastic container. Medications for the CCC are stored in the Pacheco Elementary School Nurse's Office.

The restroom used by children is observed in sanitary operating condition and the CCC has a waste bin with tight fitting lids.

The outdoor playground area is enclosed by chain linked fencing. The fence’s entry/exit
(CONT 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022
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: PACHECO ELEMENTARY SCHOOL
FACILITY NUMBER: 406213771
VISIT DATE: 03/07/2022
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gates are secured and furnishings in the area is age appropriate. The play structures in the outdoor play area has adequate cushioning materials (i.e. rubber matting) to absorb falls. Shade is provided by trees and the building overhangs in the area. No bodies of water are observed on site.

Staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well immuization records. Staff records were reviewed with the Director's CPR and First Aid Certification expiring 8/29/23. The Director 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.

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 Monica Garcia.

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

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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