406213772-2-8-2022-17-CC-EBAY-CBFS96-20220208124012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406213772
Report Date: 02/08/2022
Date Signed: 02/08/2022 12:40:19 PM

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:	HAWTHORNE ELEMENTARY SCHOOL		FACILITY NUMBER:	406213772
ADMINISTRATOR:	BRITTANY TRICAMO		FACILITY TYPE:	850
ADDRESS:	2125 STORY ST.RM K A		TELEPHONE:	(805) 596-4070
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	30	CENSUS: 16	DATE:	02/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Fiona Lloyd-Moffett		TIME COMPLETED:	12:30 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 2/8/22, 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 Fiona Lloyd-Moffett, 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 (Room K A) on the grounds of Hawthorne Elementary School. The CCC's hours of operation are 8:25 AM to 12:25 PM, Tuesday - Friday. On Mondays, the CCC hours of operation are from 9:25 AM to 12:25 PM. During the inspection, LPA observed 16 children in care along with a teacher and and teacher aide proving supervision, 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 for children in care. The CCC provides lunches and a midmorning snack for children in care. Food items come to the CCC from Hawthorne Elementary School. There is available drinking water for children both inside and outside of the classroom. LPA observed a snack menu posted near the entry of the CCC. Additionally, LPA observed required notices and documents posted on the classroom's wall near the entry. LPA reviewed children's In/Out forms upon entry and found that the documents were completed appropriately. LPA observed an operable carbon monoxide detector on the wall of the classroom. The detector was tested at 12:25 PM and found to be operable. Disinfectants and cleaning solutions are stored in a locked cabinet in the CCC. Sharps are observed on an elevated shelf in the CCC. Medications are stored in the Hawthorne 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. (CONT 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: HAWTHORNE ELEMENTARY SCHOOL	FACILITY NUMBER: 406213772
	VISIT DATE: 02/08/2022

NARRATIVE

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The outdoor playground area is enclosed by chain linked and wrought iron fencing. The fence’s entry/exit gates are secured and furnishings in the area are age appropriate. The play structures in the outdoor play area has adequate cushioning materials (i.e. wooden chips and rubber matting) to absorb falls. Shade is provided by trees 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 an immuization records. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA) along with Mandated Reporter certifications. 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 Fiona Lloyd-Moffett.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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