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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203355
Report Date: 10/28/2019
Date Signed: 10/28/2019 12:36:54 PM

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:
10/28/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Maria RuizTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection regarding a self reported incident which occurred on Friday, October 25, 2019. LPA met with Site Supervisor, Ms. Maria Ruiz and purpose of the visit was discussed. There were no children present during the visit. Center operates day care program from Tuesday to Friday, morning and afternoon sessions, 8:00 AM to 11:30 AM and 1:00 PM to 4:30 PM. Mondays are staff work days. LPA toured the Center inside and out. The children are dropped off in front of the building with two coded gate locks. The backside of the building is an alley and a parking area for Community Care Action Commission (CAC) cars.

On 10/28/2019, 9:40 AM, interview with Ms. Ruiz revealed that on Friday, October 25, 2019 about 1:00 PM, Staff 1 observed a homeless individual was looking through the window glass (backside of the building). Staff 2 sitting close to the window was alerted by Staff 1. Staff 2 got up and looked down through the window. Staff 2 observed the said individual sat down and was exhibiting obscene behavior. Ms. Ruiz stated day care children did not observe the incident.

The incident was immediately reported to Santa Maria Police Department and the individual was taken by the police officers as observed and witnessed by Staff 2

No deficiency was cited during today's visit.

LPA observed Site Supervisor 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: 10/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019
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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