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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712020
Report Date: 09/04/2019
Date Signed: 09/04/2019 11:49:14 AM

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 - SIERRA MADRE CENTERFACILITY NUMBER:
421712020
ADMINISTRATOR:CASSANDRA HARTFACILITY TYPE:
850
ADDRESS:1002 E. SIERRA MADRE AVE.TELEPHONE:
(805) 349-9707
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:50CENSUS: 33DATE:
09/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carla AyalaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual/random and met with Site Supervisor, Ms. Carla Ayala. There were total of 33 children and 6 qualified teachers. The Center uses 2 classrooms identified as full day and extended part day classrooms. LPA observed that classrooms are equipped with age and size appropriate furniture and equipment. Water jug supplies the drinking water in the classroom and in the play ground. Playground is enclosed with appropriate fence. Adequate amount of cushioning sand material is in place. Adequate shade is provided. Food preparation area is equipped with refrigerator, sink, storage area. There are no bodies of water observed. Site Supervisor stated there are no guns nor ammunition in the center.

Each Classroom has functioning carbon monoxide and smoke detectors. CPR and First aid expires on 10/20/20. Teachers files were reviewed, staff have record of immunization on file, AB 1207 Mandated Reporter Training were taken. Educational qualification was verified. LPA observed licensing documents are posted. Children's files were randomly reviewed. Sign in Sign out was complete. LPA discussed the Effects of Lead Exposure.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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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 - SIERRA MADRE CENTER
FACILITY NUMBER: 421712020
VISIT DATE: 09/04/2019
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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173and 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

During today's inspection, no deficiency was cited.

LPA observed Site Director posted the notice of Site Visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
LIC809 (FAS) - (06/04)
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