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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215336
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:04:01 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:FUSD - SAN CAYETANO PRE SCHOOLFACILITY NUMBER:
566215336
ADMINISTRATOR:LORENA RAMOSFACILITY TYPE:
850
ADDRESS:514 MOUNTAIN VIEW ST.TELEPHONE:
(805) 524-6040
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:24CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lorena RamosTIME COMPLETED:
10:52 AM
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On November 19, 2021 at 10:00 AM. Licensing Program Manager (LPM) George Mingle, Licensing Program Analysts (LPAs) Francisco Pedroza and Dean Thompson met with facility Director Lorena Ramos and Office Manager Amelia Dominguez for an Informal Conference office meeting at the Department of Social Services, Santa Barbara Regional Office. Due to the COVID - 19 and the Department of Public Health guidelines of social distancing, a virtual tele-meeting was conducted via Zoom. The purpose of the office meeting was to discuss recent concerns with the operation of a Child Care Center Pursuant to Title 22, Division 12 of the California Code of Regulations.

Deficiencies and Concerns discussed:
  • Children Records
  • Admission Agreements
  • Child's Medical Assessments
  • Immunization
  • Personnel Requirements
  • Responsibility for Care and Supervision

In response to the discussion, Director has agreed to the following:
  • Director shall submit a written statement indicating how they will maintain compliance with California Code of Regulations, Title 22, Division 12 at all times by 12/6/2021.
  • Facility will provide a written plan of correction and notify the RO of completion of files for all children enrolled. LPA will conduct a CM inspection to review files within 30 days.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER: 566215336
VISIT DATE: 11/19/2021
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  • Director shall provide periodic training to staff and submit a training roster signed by all staff and topics covered to the Department every month for the next six (6) months during the two (2) year compliance period.
  • Director shall have their staff complete the following training: Supervising Children in Child Care Centers and Children's Personal Rights in Child Care no later than 12/19/21. Staff are to provide written feedback of this video for their personnel file which will be verified during inspections.


An exit interview was conducted with Director Lorena Ramos. Director Ramos agreed to receive a copy of report via email and voiced understanding that the delivery receipt confirmation will be in lieu of her signature once she received the report. LPA requested a signed copy of the report for records.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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