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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215499
Report Date: 06/05/2019
Date Signed: 06/05/2019 04:03:51 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:ZACA CENTER PRESCHOOLFACILITY NUMBER:
426215499
ADMINISTRATOR:SHELLEY GRANDFACILITY TYPE:
850
ADDRESS:27 SIX FLAGS CIRCLETELEPHONE:
(805) 688-0050
CITY:BUELLTONSTATE: CAZIP CODE:
93427
CAPACITY:43CENSUS: 13DATE:
06/05/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Shelley GrandTIME COMPLETED:
04:15 PM
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(3) Licensing Program Analyst (LPA) Ruth Gull made an unannounced CASE MANAGEMENT inspection in order to complete the Random Annual which was initiated on 05/08/19. Met with Shelley Grand, Director and explained the purpose of the visit. The center was toured both inside and outside. LPA reviewed a sampling of staff and children records and the parent sign in/out sheets. LPA reviewed SB 792 (Child Care Employee and Volunteer Immunization and Tuberculosis Requirements). Director and the 2 teachers present have current 1st Aid/CPR certificates valid through 02/08/20.
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. Director previously submitted an IMS Plan of Operation.

Director is reminded that it is her responsibility to know the Child Care Center regulations which can be accessed online at www.ccld.ca.gov.

There were no deficiencies observed in the areas evaluated during today's inspection.


The LIC 9213 (Notice of Site Visit) was posted during the visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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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