426200196-5-8-2024-17-CC-MJIZ-D54266-20240508170636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426200196
Report Date: 05/08/2024
Date Signed: 05/08/2024 05:06:43 PM

Document Has Been Signed on 05/08/2024 05:06 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 - ALVIN CENTER		FACILITY NUMBER:	426200196
ADMINISTRATOR:	MARIA BEAS		FACILITY TYPE:	850
ADDRESS:	316 E. MCELHANY		TELEPHONE:	(805) 347-1975
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	23	CENSUS: 15	DATE:	05/08/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Romina Andrade		TIME COMPLETED:	05:20 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 05/08/24, Licensing Program Analyst (LPA) Martina Jimenez made an unannounced inspection to the Child Care Center (CCC) to follow up on a self- reported unusual incident that occurred in the CCC on 03/28/24. LPA met with Romanda Andrade, Teacher Assistant, of the CCC and advised of the purpose of this inspection. At 2:52pm, Asael Picasso, Program Manager arrived to the center. LPA observed 15 children being cared by 3 staff during this inspection. On 03/28/24, CCLD received a self reported unusual incident report from the CCC, detailing an incident in which Child 1 (C1) was left unsupervised in the play area for three (3) minutes. C1 was observed by a parent who advised S3 there was a child in the play area under the canopy. CCLD received a phone call from the S1, notifying CCLD that C1 was unaccounted for after the children went to the bathroom. Child was then found about 3 minutes later by another staff member. It was reported C1 was left in the center's play area unattended for about 3 minutes. On 05/8/24, CCLD interview staff present at the CCC when the incident occurred. Interviews revealed during transition time from music time outside to inside lunch time .C1 ran into the classroom to use the restroom, C1 did not remove his name card from the exterior board or remove his shoes. C1 was directed by S1 & S2 to go outside, remove the name card from the board, remove his shoes and come back inside. Continues 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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 - ALVIN CENTER	FACILITY NUMBER: 426200196
	VISIT DATE: 05/08/2024

NARRATIVE

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When S3 was returning from lunch a parent asked S3 is that child one of yours and pointed at C1 who was on his knees, on the bench under the canopy. S3 walked over to C1, took him by the hand, escorted C1 into the classroom, and advised S1 C1 was left in the outside play area unsupervised.

Based on the interviews with staff, it was determined that C1 was left in the outside play area unsupervised for 3 minutes.

Today, A Technical Assistance is being issued based on LPAs' observation, interviews and record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 9102). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

Exit interview and report was reviewed with Asael Picasso. Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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