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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207802
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:00:37 PM


Document Has Been Signed on 02/17/2023 01:00 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 - "I" STREET CENTERFACILITY NUMBER:
426207802
ADMINISTRATOR:NOHEMY ESTRADAFACILITY TYPE:
850
ADDRESS:228 NORTH I ST.TELEPHONE:
(805) 735-8392
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:38CENSUS: 25DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Shonna MartinTIME COMPLETED:
01:02 PM
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On February 17th, 2023, at 11:06AM, Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. A Covid 19 questionnaire was assessed and there was no exposure on site. LPA met with facility director Shonna Martin and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. The center operates Monday-Friday from 8:15AM – 3:00PM. At the time of the inspection there were twenty-five (25) children, and five (5) teachers present.

LPA observed required licensing documents mounted on the wall at the entrance of the facility and the menu for the month of February 2023. Facility uses written sign in out logs for attendance. The facility is currently using two (2) classrooms for care and supervision. Both classrooms have age-appropriate toys and furniture readily accessible for children in care and offers ample ventilation. Children utilize private cubbies for personal belongings. LPA observed, disinfectants, sharps, and tools to be inaccessible to children and / or locked in a cabinet. Mats are used for naptime, and LPA observed to be clean with individual bedding stored separately. LPA observed the facility has a sufficient number of restrooms and sinks available for the children, which are functioning and clean. LPA observed first aid kits available in both classrooms. Facility provides filter water for children and handwashing sinks in each classroom. Facility provides breakfast, lunch, and snack. Kitchen was observed to be clean, orderly, and with no pests present.

Emergency drills were last conducted on 1/26/2023 and 2/10/2023. Regulation fire extinguisher was serviced 12/1/2022. Director stated no firearms or ammunition are present on the property.

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023
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 - "I" STREET CENTER
FACILITY NUMBER: 426207802
VISIT DATE: 02/17/2023
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The outdoor area has an ample amount of space for children to play with appropriate toys and equipment, shade, handwashing sink and filtered water. No bodies of water are present.

At this time, no Incidental Medical Services are being provided.

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. Teachers present has current Pediatric CPR/First-Aid certificates that is valid until 4/30/2024. Teachers present have Mandated Reporter certificates that are valid and current at the time of the inspection. Facility is currently following Covid-19 guidelines.

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

CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
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 - "I" STREET CENTER
FACILITY NUMBER: 426207802
VISIT DATE: 02/17/2023
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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 review and copy provided to director.

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 TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3