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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203355
Report Date: 06/21/2019
Date Signed: 06/21/2019 03:30:27 PM

COMPREHENSIVE INSPECTION
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 - J. C. WASHINGTON CENTERFACILITY NUMBER:
426203355
ADMINISTRATOR:SILVIA SEGOVIANOFACILITY TYPE:
850
ADDRESS:201 W. CHAPEL ST.TELEPHONE:
(805) 922-2243
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:20CENSUS: 0DATE:
06/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Kim EichertTIME COMPLETED:
03:40 PM
NARRATIVE
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An annual random/comprehensive inspection was conducted by LPA S. Mendoza-Ceja who met with Program Manager Kim Eichert. LPA was advised there were no children in care. The center will re-open on August 19, 2019. The Program Manager escorted LPA through the center inside and outside. The preschool operates, Monday - Friday, 8:00 AM - 4:30 PM. The classroom was observed to be clean and orderly. The appropriate documents were posted for review. There is carbon monoxide detector in the classroom. The medication policy was reviewed. When medication is accepted it is maintained in a locked box inaccessible to children/or in a locked box in the refrigerator. The last fire drill was conducted on 05/14/2019 and earthquake drill 05/15/2019. The restrooms were observed to clean. The outside playground equipment was inspected. Children's record keeping requirements were reviewed. LPA reviewed the new Site Supervisor's Maria Ruiz qualifications which includes current CPR and First Aid. LPA also reviewed the handout “A Child Care Provider’s Guide to Safe Sleep and Effects of Lead Exposure”. LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised, each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or obtain a sign statement declining the influenza vaccination. LPA also reviewed AB 1207 Child Mandated Reporter Training.

This facility provides Incidental Medical Services – IMS. LPA 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

No deficiencies cited. The Notice of Site Visit was posted at the 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) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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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