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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214424
Report Date: 02/19/2020
Date Signed: 02/19/2020 12:24:07 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:CAPSLO-NIPOMO HEAD STARTFACILITY NUMBER:
406214424
ADMINISTRATOR:WILLIAM CASTELLANOSFACILITY TYPE:
850
ADDRESS:291 THOMPSON ROADTELEPHONE:
(805) 544-4355
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:30CENSUS: 22DATE:
02/19/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Soccoro CanoTIME COMPLETED:
12:28 PM
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On 2/19/2020 at 10:48 am, Licensing Program Analyst (LPA) Christian Patterson made an unannounced inspection to the facility for the purpose of conducting a Required 1-year inspection. LPA met with Site Supervisor Socorro Cano and explained the purpose of the inspection. The facility operates Monday- Friday from 7:30am-4:45pm. There were 22 children present. A tour of the facility was made both inside and outside. The classrooms were observed to have age appropriate furniture/equipment. The restroom was observed to be clean and free of toxins. There is a functioning smoke/carbon monoxide detector in the classroom. All required State forms and daily menu were posted. The outdoor play area is completely fenced. LPA observed age appropriate equipment. Drinking water is available inside and outside.

Teacher files reviewed and were found to be complete. Teacher's Medical Health Records were verified. At least one teacher in the classroom has valid Pediatric CPR/First Aid which expires on 08/09/2021. Center staff have completed AB1207 Mandated Reporter Training. Sign in and sign out verified and matched census. Children's files were reviewed and found to be complete.

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
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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-NIPOMO HEAD START
FACILITY NUMBER: 406214424
VISIT DATE: 02/19/2020
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Director is reminded that they are responsible for knowing the regulations for a Child Care Center and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Director with Infant Safe Sleep and Effects of Lead Exposure Brochures


There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was posted in LPA's presence.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
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