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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426205577
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:47:43 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 - FILLMORE CENTERFACILITY NUMBER:
426205577
ADMINISTRATOR:SHONNA MARTINFACILITY TYPE:
850
ADDRESS:1316 E. OAK ST.TELEPHONE:
(805) 736-2811
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:45CENSUS: 29DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Shonna MartinTIME COMPLETED:
12:55 PM
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An annual review was conducted by LPA S. Mendoza-Ceja who met with Site Supervisor Shonna Martin and Program Manager Maria Douvia. The center was toured inside and outside. The preschool operates Monday - Friday, 7:15 AM - 5:30 PM. LPA reviewed the medication which is maintained in a locked box inaccessible. The classroom was observed to be clean and orderly. The appropriate documents including the menu, Effects of Lead Exposure were posted for review. LPA discussed the handout “A Child Care Provider’s Guide to Safe Sleep and Effects of Lead Exposure”. There is carbon monoxide detector in both classrooms. The restrooms were observed to clean. The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records and the sign in/out sheets to ensure legal signature is used. Staff records were reviewed for new staff. LPA reviewed current CPR and First Aid for

LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA reviewed verification of immunization for new staff, including CPR and First Aid.

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 in both classrooms.



FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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