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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213704
Report Date: 09/22/2021
Date Signed: 09/27/2021 11:28:54 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 - OAK VALLEY CENTERFACILITY NUMBER:
426213704
ADMINISTRATOR:VERONICA RUBIOFACILITY TYPE:
850
ADDRESS:595 2ND STREET, #109TELEPHONE:
(805) 688-6992
CITY:BUELLTONSTATE: CAZIP CODE:
93427
CAPACITY:22CENSUS: 5DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Veronica RubioTIME COMPLETED:
11:25 AM
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This is an amended report for the inspection conducted on 9/22/2021 to state the correct room number 109 being used by the Child Care Center.

On 9/22/2021, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Required Annual inspection of the above mentioned Child Care Center (CCC). Prior to inspection LPA asked pre screening questions related to COVID 19, Site Supervisor response indicate there was no COVID exposure on site. LPA met with Veronica Rubio, Site Supervisor and explained the nature of the inspection. There were 5 children present and 3 staff present. The day care children were playing at the playground supervised by 2 staff when LPA arrived. The CCC operates from 8:45 AM to 12:45 PM and is located at Oak Valley Elementary School, Room 109

During the tour, the following were observed, classroom is adequately equipped with age and size appropriate furniture and equipment. Water pitcher supplies drinking water in the indoor activity space. Playground is enclosed by an appropriate fence. Outdoor activity area is equipped with age and size appropriate equipment. An adequate amount of cushioning material, wood chips are in place under play equipment. Drinking water is provided in the outdoor play area by a water pitcher, disposable paper cups are supplied. There is a working carbon monoxide detector in the classroom.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information.

Continued on LIC 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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 - OAK VALLEY CENTER
FACILITY NUMBER: 426213704
VISIT DATE: 09/22/2021
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A review of staff records on 9/22/2021 indicates that all facility staff have criminal record clearance. Educational qualifications of each staff were reviewed and verified. CPR and First Aid expires on 11/5/2022. Sign in and sign out record meets the regulation requirements. AB 1207 Mandated Report Training was completed on 10/23/2019. Site Supervisor is aware AB 1207 should be renewed every two years.

Director noted no firearm or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes 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.htmhttp://www.ada.gov/childqanda.htm

In areas evaluated, Center is in compliance of Title 22 Division 12 of California Code of Regulations and Health and Safety Code.


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

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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