426200196-10-21-2024-17-CC-GNEE-DAA22L-20241021170056

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426200196
Report Date: 10/21/2024
Date Signed: 10/21/2024 05:01:08 PM

Document Has Been Signed on 10/21/2024 05:01 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
SANTA BARBARA CC RO, 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: 13	DATE:	10/21/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Asael Picasso		TIME COMPLETED:	04:20 PM

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On 10/21/2024 Licensing Program Analyst (LPAs) German Negrete and Mathew Saipen made an unannounced inspection for the purpose of conducting a Case Management - Incident report. LPAs met with Program Manager and informed them the purpose for todays inspection. Today, LPAs did a walk through of the Child Care Center with the Program manager. LPAs observed at the time of the walk-through 13 children being supervised by 2 staff.

Facility contacted Community Care Licensing (CCL) to self-report the following unusual incident : On 09/12/2024 Child#2(C2) was in the block area playing. Then Child#1(C1) went to the clock area in order to play with the blocks. C1 then covered up the blocks C1 was playing with. C2 became upset and hit C1 on the cheek. No photo of C1 was taken. C1 was offered Ice. C1 refused ice.

The Unusual Incident Report (LIC624) was received via email on 09/19/2024 . The LIC624 provided details on the preventative measure the facility took which included the following

1.Separated the children and found C1 another activity.

2.C2 continued building with the blocks. S1 talked to C1 that C2 was sad, including cards to show C2 was sad.

Continued on LIC809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024

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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAC - ALVIN CENTER	FACILITY NUMBER: 426200196
	VISIT DATE: 10/21/2024

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3.We are going to read a book Tuesday about "touching others". We are working with Behavior Services for C#1.

4.C2 was offered ice and comforted. C2 and apologized to c1.

During the file review LPA discovered an additional unusual incident that was self reported to the department on 4/12/2024 via telephone. A summary of the report is listed below:

Time C1 was assisting with water table clean up, C2 reach to take the container from C1, C1 said no and C2 hit C1 on his upper chest. S2 separated the chidlren.

The written unusual incident report (LIC624) was submitted on 4/19/2024 via email.

During the todays inspection LPAs completed a children’s file review(see LIC857)

Parents were informed and and ouch report was provided to parents.

LPAs also completed a facility file review and verified the facility submitted both written LIC624s as outlined on title 22 California code of regulations section 101212 reporting requirements.

No citations will be issued today

Exit Interview was conducted with program manager.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German Negrete	TELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024

LIC809 (FAS) - (06/04)

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