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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215099
Report Date: 11/19/2019
Date Signed: 11/19/2019 02:22:21 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:SBCEO - SANTA MARIA CAL SAFEFACILITY NUMBER:
426215099
ADMINISTRATOR:JANELLE WILLISFACILITY TYPE:
830
ADDRESS:829 SOUTH LINCOLNTELEPHONE:
(805) 925-2567
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:17CENSUS: 5DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brittany Wells and Edith SolanoTIME COMPLETED:
02:30 PM
NARRATIVE
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(1) Licensing Program Analyst (LPA) Ruth Gull made an unannounced RANDOM ANNUAL inspection to the center. Met with Brittany Wells, teacher and explained the purpose of the visit. Edith Solano, Acting Site Supervisor arrived from lunch during the inspection. Former Site Supervisor Maria Comacho's last day was 11/15/19. This is a combination Infant and Preschool program which is funded by the State Department of Education and operates under Title 5. The center operates Monday - Friday from 7:00am to 4:00pm. A tour of the Infant program was made both inside and outside. There are age appropriate toys/furnishings. There are 2 changing tables. LPA observed that the immobile changing table in the bathroom is not within arm's reach of the sink when in use. Individual bottles/food are labelled. The center serves breakfast, lunch and snacks. Posted menu was reviewed. The playground has age appropriate toys/equipment. LPA reviewed a sampling of Individual needs & services plans and feeding plans. LPA observed that Child #1 did not have a Needs and Services plan and that Child #2's plan was signed and dated 03/18/19. LPA also reviewed children and staff records. LPA reviewed parent sign in/sign out sheets. LPA reviewed Staff files for required AB1207 Mandated Reporter Training and proof of required immunizations/TB screening. At least 3 of the staff present have current Pediatric 1st Aid/CPR certificates (approved by EMSA or provided by the American Heart Association) valid through at least 10/2020.

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 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. Program Director previously submitted an IMS Plan of Operation.

CONTINUED ON LIC 809-C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SBCEO - SANTA MARIA CAL SAFE
FACILITY NUMBER: 426215099
VISIT DATE: 11/19/2019
NARRATIVE
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Ms. Solano was reminded that it is her responsibility to know the Child Care Center regulations which can be accessed online at www.ccld.ca.gov. LPA reviewed and provided Ms. Solano with A Guide to Safe Sleep for Infants and a pamphlet regarding Effects of Lead Exposure (to be provided to both current and future parents).

Pursuant to Title 22 of the California Code of Regulations, the following Type B deficiencies were cited (refer to LIC 809-D). Ms. Solano was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.

The LIC 9213 (Notice of Site Visit) was posted.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SBCEO - SANTA MARIA CAL SAFE
FACILITY NUMBER: 426215099
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/26/2019
Section Cited

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101439(h)(4) Infant Care Center Fixtures, Furniture, Equipment and Supplies - Infant changing tables shall: While in use, be placed within arm's reach of a sink.
This requirement was not met as evidenced by LPA observed that the immobile changing table located in the bathroom was not within arm's reach of a sink. This poses a potential health
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risk to children in care.
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Type B
11/26/2019
Section Cited

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101419.2(a) Infant Needs and Services Plan - Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant.
This requirement was not met as evidenced by LPA's review of records reveals that C#1 was enrolled in 08/2019 and did not have a
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Needs and Services Plan. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SBCEO - SANTA MARIA CAL SAFE
FACILITY NUMBER: 426215099
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2019
Section Cited

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101419.3(a) Modifications to Infant Needs and Services Plan - The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.
This requirement was not met as evidenced by LPA's review of records reveals that Child #2's Needs and Services plan was signed and
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dated 03/18/19. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4