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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208270
Report Date: 05/10/2024
Date Signed: 05/10/2024 04:03:31 PM

Document Has Been Signed on 05/10/2024 04:03 PM - It Cannot Be Edited

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:CAPSLO - SANTA ROSA EARLY EDUCATION & CHILD CAREFACILITY NUMBER:
406208270
ADMINISTRATOR/
DIRECTOR:
A. RAMIREZ-BARRONFACILITY TYPE:
850
ADDRESS:864 SANTA ROSATELEPHONE:
(805) 594-1752
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY: 17TOTAL ENROLLED CHILDREN: 17CENSUS: 14DATE:
05/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Megan LarkinTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 5/10/24, at 12:30 PM Licensing Program Analyst (LPA) Elvin Baddley conducted unannounced Annual/Random Inspection of abovementioned Child Care Center (CCC). LPA met with Megan Larkin, Site Supervisor of the CCC and explained the purpose of the inspection. LPA toured the interior and exterior of the CCC. The CCC operates from a single classroom from 8:00 AM to 4:30 PM, Monday - Friday. The CCC has a population of 14 children in care at the time of the inspection along with three adults (teacher/aide) providing supervision. LPA note Site Supervisor also assisted with the care and supervision of children.

The classroom of the CCC was clean and organized. The classroom has age appropriate toys and furnishings available for children in care. The classroom has a carbon monoxide detector. LPA did not test the detector as children in care where napping at various times during the inspection. The bathrooms of the CCC are observed in safe and sanitary operating condition. The attached kitchen was observed to be clean and free of litter. Within the kitchen is a refrigerator which contains items consumed by children. The CCC has a locked cabinet in the kitchen area for the storage of medication. Disinfectants and cleaning solutions are observed in the kitchen area, while sharps are located in an upper drawer cabinet in the office area. Each location is inaccessible to children in care.

The CCC provides breakfast, lunch and snacks to children in care. LPA observed a posted menu, along with required licensing documents on the CCC's wall. There is available drinking (filtered) water for children both inside the classroom and outside in the play area. CCCs constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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: CAPSLO - SANTA ROSA EARLY EDUCATION & CHILD CARE
FACILITY NUMBER: 406208270
VISIT DATE: 05/10/2024
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The CCC has First Aid kits available to facility staff and inaccessible to children. LPA reviewed Children Sign In/Out forms. LPA notes the forms contained the arrival and departure times of children as well the signature of their authorized representatives. LPA notes the last fire drill occurred on site on 4/30/24.

The CCC's outdoor play area is enclosed by chain linked and wooden fencing. The footing in the area is varied. The fence’s entry/exit gates are secured. The LPA observed age appropriate toys/play equipment in the play area. The toys/play equipment are in suitable condition and free of sharp, loose or pointed objects. The play structure in the play areas have an adequate cushioning materials to absorb falls and an abundance of shade created by building overhangs and tress. The outdoor play area contains three secured sheds. Within the sheds are CCC supplies and equipment. LPA observed no bodies of water on site. Waste receptacles with tight fitting covers were observed throughout the CCC.

LPA reviewed staff and children records. The children’s records are complete and found to contain emergency contact information as well as immunization records, amongst other required licensing documents. Staff records are reviewed and contained current Pediatric CPR/First Aid, Mandated Reporter certifications and educational experience, amongst other required licensing documents. Site Supervisor informed LPA no firearm or ammunition is stored on site.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address
(CONT. 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
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: CAPSLO - SANTA ROSA EARLY EDUCATION & CHILD CARE
FACILITY NUMBER: 406208270
VISIT DATE: 05/10/2024
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provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Megan Larkin
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
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