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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421709268
Report Date: 09/19/2019
Date Signed: 09/19/2019 01:44:53 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:CAC - GOLETA I CENTERFACILITY NUMBER:
421709268
ADMINISTRATOR:BETTY SANCHEZFACILITY TYPE:
850
ADDRESS:5681 HOLLISTER AVENUETELEPHONE:
(805) 967-7684
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:45CENSUS: 9DATE:
09/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Molly Jarvis and Miriam AngelTIME COMPLETED:
01:15 PM
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(1) Licensing Program Analyst (LPA) Ruth Gull conducted an unannounced RANDOM ANNUAL inspection to the center. Met with Molly Jarvis, Site Supervisor and Miriam Angel, Program Manager and explained the purpose of the inspection. The center was toured inside and outside. The preschool operates Monday - Friday, 7:00 AM - 5:00 PM. The classroom and attached bathroom were observed to be clean and orderly. The posted menu was reviewed. There is a dual carbon monoxide/smoke detector in the classroom. The outside playground equipment was observed to be well maintained and age appropriate. A sampling of children records was reviewed. Ms. Jarvis and at least 1 teacher present have current CPR and First Aid certificates valid until at least 10/14/19.

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. The center has previously submitted an IMS plan of operation to the department.

Due to time constraints, the annual inspection will continue at a later date.

Ms. Jarvis was reminded that it is her responsibility to know the Child Care Center regulations which can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Ms. Jarvis with a pamphlet regarding Effects of Lead Exposure (to be provided to both current and future parents).



There were no deficiencies cited in the areas inspected.
The LIC 9213 (Notice of Site Visit) was posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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