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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426200008
Report Date: 05/14/2019
Date Signed: 05/14/2019 11:51:29 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 - ADAM CENTERFACILITY NUMBER:
426200008
ADMINISTRATOR:RALPH YBARRAFACILITY TYPE:
850
ADDRESS:500 W. WINDSOR ST.TELEPHONE:
(805) 925-6667
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:24CENSUS: 17DATE:
05/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Rebecca RomeroTIME COMPLETED:
10:50 AM
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Licensing Program Analysts (LPAs) Martina Jimenez and Melissa Stewart conducted an annual inspection and met with Rebecca Romero, Site Supervisor. The center was toured inside and outside. The preschool operates Monday - Friday, 7:30 AM - 5:30 PM. LPAs reviewed the medication which is maintained in a locked box inaccessible to children. The classroom are clean, orderly. The appropriate documents including the menu was posted for review. There is carbon monoxide detector in the classroom. The restrooms were observed to clean. The outside playground equipment was observed to be well maintained and age appropriate for children LPAs a review of children's records. The sign in/out sheets to ensure legal signature is used. Staff records were reviewed. LPAs reviewed current CPR and First Aid for four staff.

LPAs reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPAs reviewed staff files and verification of immunization for staff.

This facility provides Incidental Medical Services – IMS. LPAs 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

Staff has complete the Mandated Reporter Training required per AB 1207. LPAs reviewed the handout "A Child Care Provider's Guide to Safe Sleep." LPAs provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. There were no deficiencies cites at this time. LPAs observed the Site Supervisor post the Notice of Site visit. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2019
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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