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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203355
Report Date: 03/11/2020
Date Signed: 03/17/2020 11:50:01 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 - 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: 14DATE:
03/11/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria RuizTIME COMPLETED:
03:15 PM
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On March 11, 2020 at 1:25 pm Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual Required Inspection and met with Site Supervisor, Maria Ruiz, LPA disclosed the purpose of the inspection and the entry was granted by the Site Supervisor. There were 14 children and 3 staff present during the inspection. The center provides day care into two (2) different sessions, 8:00 am to 11:30 am and 1:00 pm to 4:30 pm. Site Supervisor accompanied LPA toured the Center in and out.

LPA observed age appropriate toys, books furniture and equipment in the indoor activity area. Water jug supplies drinking water in the indoor activity space. Playground is enclosed by appropriate fence. Outdoor activity area is supplied with age and size appropriate equipment. An adequate amount of green turf cushioning material is in place under play equipment. Drinking water is provided in the outdoor play area by a water jug LPA did not observe any bodies of water. Site Supervisor stated there are no guns or ammunition in the Pre School. Classroom and Children's bathrooms are free of toxin. Licensing forms are posted in the lobby of the center.

At 1:30 pm, Staff 2 tested the Carbon Monoxide located in the classroom and found functional. Continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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 - J. C. WASHINGTON CENTER
FACILITY NUMBER: 426203355
VISIT DATE: 03/11/2020
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LPA review of staff record on 3/11/2020 revealed that all center staff have received criminal record clearance . Staff have complete record of immunization. CPR and First Aid expires on 4/28/2020. Staff have taken the AB 1207 Mandated Reporter Training. Site Supervisor was reminded that AB 1207 should be taken every two years.
LPA reviewed children's files in random and found complete.

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

LPA discussed “Effects of Lead Exposure” brochure . Site Supervisor stated that they have been providing the flyer to parents of day care children.



There were no deficiencies cited at this time.

LPA observed the 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: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
LIC809 (FAS) - (06/04)
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