421709268-8-3-2022-17-CC-GRES-CGXSPQ-20220803140332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421709268
Report Date: 08/03/2022
Date Signed: 08/03/2022 02:03:36 PM

Document Has Been Signed on 08/03/2022 02:03 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:	CAC - GOLETA I CENTER		FACILITY NUMBER:	421709268
ADMINISTRATOR:	BETTY SANCHEZ		FACILITY TYPE:	850
ADDRESS:	5681 HOLLISTER AVENUE		TELEPHONE:	(805) 967-3637
CITY:	GOLETA	STATE: CA	ZIP CODE:	93117
CAPACITY:	45	CENSUS: 8	DATE:	08/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Richard Gonzales		TIME COMPLETED:	02:00 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 August 3, 2022 at 9:50 AM , Licensing Program Analyst (LPA) GIgi Reyes conducted an unannounced Required 1- Year Inspection and met with new Site Supervisor, Richard Gonzales. LPA asked pre screening questions related to COVID -19 and Site Supervisor responses indicates there are no COVID 19 exposures on site. LPA discussed the purpose of the inspection. There were 8 children and 6 staff present including the Site Supervisor. The Center operates the full day class from 7:00 AM to 5:00 PM Monday to Friday. LPA in the company with Site Supervisor toured the Child Care Center (CCC) Facility which occupy two classrooms. At the time of the inspection, only classroom A is being used since the part day class is temporarily closed. LPA observed Licensing required forms are posted in the wall where the parents sign in and out. Copies of the required forms are also posted in each classroom. The classrooms are equipped with age appropriate games, activities, and furniture available for children in care. LPA observed and reviewed the posted menu. The center provides breakfast, lunch and snack. Water jug dispenser supplies the drinking water inside and outside the classroom. The outdoor playground is completely fenced with age appropriate toys and equipment. The playground has an ample amount of shade available and cushioning under the play equipment. CCC sign-in/sign out log is complete. A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have Pediatric First Aid/CPR certificates that expire on 3/12/2024. Teachers have current AB 1207 Mandated Reporter Training certificates that expire on 2/14/2024. Teachers required immunization per SB 792 are on file . Based on record review Mr. Gonzales started the employment at the CCC on July 18, 2022 but assumed the position as a Site Supervisor on 7/27/2022. Site Supervisor's qualification was verified during the inspection. No deficiencies were cited during today's visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

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: CAC - GOLETA I CENTER	FACILITY NUMBER: 421709268
	VISIT DATE: 08/03/2022

NARRATIVE

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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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Site Supervisors were 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 Site Supervisor, Mr. Richard Gonzalez

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

LIC809 (FAS) - (06/04)

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