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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215332
Report Date: 05/23/2019
Date Signed: 05/23/2019 11:37:32 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:CARPINTERIA STATE PRESCHOOLFACILITY NUMBER:
426215332
ADMINISTRATOR:MARIA FISKFACILITY TYPE:
850
ADDRESS:4545 CARPINTERIA AVENUETELEPHONE:
(805) 566-1600
CITY:CARPINTERIASTATE: CAZIP CODE:
93013
CAPACITY:24CENSUS: 21DATE:
05/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Martha Haro and Lourdes CorderoTIME COMPLETED:
11:40 AM
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An annual review was conducted by LPA S. Mendoza-Ceja who met with Program Director Martha Haro and Teacher Lourdes Cordero. The center was toured inside and outside. The preschool is located on Alisos Elementary School and operates Monday – Friday, 8:00 AM - 11:00 AM. LPA was advised there is no medication being administered at this time. LPA asked if there are firearms and ammunition or bodies of water on the premises. The Program Director stated there are no firearms or ammunition or bodies of water on the premises. The classroom was observed to be clean and orderly. The menu was posted for review. The food service is provided by the school cafeteria. There is a carbon monoxide detector in the The restrooms was observed to clean. LPA reviewed the handouts “A Child Care Provider’s Guide to Safe Sleep, Safe Sleep in Child Care, and the Effects of Lead Exposure". The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records. Staff records were reviewed. LPA reviewed current CPR and First Aid for one staff. LPA 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. LPA also reviewed the requirement of the AB 1207 Child Mandated Reporter Training staff.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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


FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
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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