426205577-3-23-2023-17-CC-MBRT-CQ7QUM-20230323122857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426205577
Report Date: 03/23/2023
Date Signed: 03/23/2023 12:29:07 PM

Document Has Been Signed on 03/23/2023 12:29 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CAC - FILLMORE CENTER		FACILITY NUMBER:	426205577
ADMINISTRATOR:	SHONNA MARTIN		FACILITY TYPE:	850
ADDRESS:	1316 E. OAK ST.		TELEPHONE:	(805) 736-2811
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	45	CENSUS: 22	DATE:	03/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Veronia Espinosa & Maria Cervantes		TIME COMPLETED:	12:43 PM

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On March 23rd, 2023, at 10:19AM, Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with lead teacher Veronica Espinosa (current designated responsible party) and advised her the purpose of the inspection. A Covid-19 assessment was taken, and teacher stated no Covid on site. During the inspection site supervisor Maria Cervantes arrived. Lead teacher provided LPA a tour of the facility inside and out. The center operates from 7:30AM-5:15PM Monday through Friday. There were twenty-two (22) children in care at the time of the inspection, and five (5) teachers.

LPA observed required licensing documents mounted on the wall at the entrance of the facility, and the menu for the month of March 2023. Facility uses written logs for the purposes of signing in and out. Facility is currently utilizing two (2) classrooms for care and supervision. LPA observed age-appropriate toys and furniture readily accessible for children in care and offers ample ventilation. Both classrooms contain emergency/first aid kids, accessible to staff and out of reach of children. LPA observed all cleaning compounds, disinfectants, sharps, poisons, and tools that may pose a danger to children to be elevated in locked cabinets. LPA observed the facility has enough restrooms and sinks available for the children, which are functioning and clean. Facility provides cots for nap time, with children’s individual bedding stored separately. Facility provides filtered water for children’s use both inside and out. Handwashing sinks are available in both classrooms and in outdoor play yard. LPA observed kitchen to be clean, free of rodents, and refrigerator / freezer is functioning properly. LPA observed regulation fire extinguishers with last service dates of 12/1/2022. Last fire/disaster drill was conducted on 3/8/2023. Lead teacher stated no firearms or ammunition are present on property.

The outdoor area has an ample amount of space for children to play with perimeter locked fencing, soft cushioning, ample shade, and free of debris, broken glass, or any other hazards. No bodies of water are present.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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 - FILLMORE CENTER	FACILITY NUMBER: 426205577
	VISIT DATE: 03/23/2023

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Incident Medical Services are currently being provided in both classrooms. In each classroom, LPA observed elevated, labeled, locked medical boxes inaccessible to children, containing children’s medication, individually labeled, bagged, with unaltered prescription stickers, and not expired.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA observed staff files to be complete and current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. Teacher present have current Pediatric CPR/First-Aid certificates that is valid until 4/30/2024. Teachers have current Mandated Reporter certificates that are valid and current.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation interpretations and procedures for Child Care Centers sections 101173 and 101226. When any IMS is provided, an updated plan of operation that includes IMS must be submitted to the Department. the follow 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No deficiencies were cited during today’s inspection.

Exit interview conducted, report was reviewed with supervising teacher, and copy provided. THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

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