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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213282
Report Date: 12/02/2022
Date Signed: 12/02/2022 02:48:27 PM

Document Has Been Signed on 12/02/2022 02:48 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 - CUESTA INFANT CENTER - RM 4021FACILITY NUMBER:
406213282
ADMINISTRATOR:A. RAMIREZ-BARRONFACILITY TYPE:
830
ADDRESS:4000 CHORRO VALLEY RDTELEPHONE:
(805) 546-3285
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
12/02/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Penny GlassTIME COMPLETED:
03:30 PM
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On 12/2/22, at 1:31 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection the abovementioned Child Care Center (CCC). The LPA met with Penny Glass, Site Supervisor of the CCC and explained the purpose of the inspection. LPA, in the company of the Site Supervisor toured the interior and exterior of the CCC. The CCC operates from the ground's of Cuesta College's Children Center in Room 4021. The CCC operates from 8:00 AM to 4:45 PM, Monday - Friday. The CCC is an infant program. At the time of the inspection, two children are present, along with one teacher (cleared and associated) proving care and supervision.

The CCC is clean and organized. LPA observed age appropriate toys and furnishings throughout the CCC. The CCC has cribs along with napping cots for children in care with various levels of mobility. LPA observed a carbon monoxide detector which was tested at 1: 40 PM and found to be operable. The CCC's bathroom is in safe and sanitary operating condition. The CCC has an operable refrigerator. The refrigerator contains the foods consumed by children. The Site Supervisor noted children in care are provided snacks, breakfast, lunches and formula, while breast milk is provided by parents. Additionally, the CCC provides the children in care filtered water both inside the facility and in the outdoor activity area. The Site Supervisor informed LPA the CCC's water sources have been tested for lead containments. Disinfectants and cleaning solutions are stored in elevated locations in the classroom. Medication in the facility is stored in a secure elevated location which is beyond the reach of children in care.

LPA observed licensing required notices, documents and forms near the entry of the CCC. LPA observed Sign In/Out forms contained in a binder. The forms contain the child's arrival and departure times as well as the signature of the authorized representatives.

CCC's outdoor play area is enclosed by vinyl fencing. The footing is varied and Site Supervisor Informed LPA paddled mats are placed on the ground for children to play on. Children also use the toddler area when
(CONT. LIC 809-C)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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 - CUESTA INFANT CENTER - RM 4021
FACILITY NUMBER: 406213282
VISIT DATE: 12/02/2022
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unoccupied. LPA observed age appropriate toys/play equipment in the play areas. The toys/play equipment are free of sharp, loose or pointed objects. No bodies of water were observed on site.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information as well as medical assessments. LPA also review sleep logs which documented the sleep of children in 15 minute intervals. Staff records were reviewed and contained pediatric CPR and First Aid certifications as well as Mandated Report certifications.

Site Supervisor notes no firearms/weapons or ammunition was stored on the premises.

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



Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an or additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 Penny Glass.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
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