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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426206184
Report Date: 05/22/2019
Date Signed: 05/22/2019 04:13:20 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:LOMPOC BRANCH - LOS BERROSFACILITY NUMBER:
426206184
ADMINISTRATOR:SAUCEDO, STEPHANIEFACILITY TYPE:
840
ADDRESS:3745 VIA LATOTELEPHONE:
(805) 733-5530
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:40CENSUS: 27DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Isabel BryantTIME COMPLETED:
04:20 PM
NARRATIVE
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An annual random was conducted by LPA S. Mendoza-Ceja who met with Isabel Bryant. The school age program operates on the grounds of Los Berros Elementary School in in classroom #27. LPA inspected the classroom and the outside playground area. LPA observed a water dispenser and cups available in the classroom and drinking fountains are available outdoors. The restrooms were also inspected. LPA was advised there is no medication being administered at this time. LPA also reviewed the handouts “A Child Care Provider’s Guide to Safe Sleep, Safe Sleep in Child Care and Effects of Lead Exposure". LPA reviewed children's records for emergency contact information and the sign in/out sheets. Staff qualifications were reviewed, including verification of AB 1207 Child Mandated Reporter Training . LPA reviewed verification of current with CPR and First Aid for one staff who present during the visit.

LPA also 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

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: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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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