421712022-10-23-2025-17-CC-MSAN-DMQVJD-20251023162835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421712022
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:28:49 PM

Document Has Been Signed on 10/23/2025 04:28 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
SANTA BARBARA CC RO; SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200; 6500 HOLLISTER AVE., SUITE 200
GOLETA; GOLETA, CA 93117; 93117

FACILITY NAME:	CAC - CUYAMA CENTER		FACILITY NUMBER:	421712022
ADMINISTRATOR/ DIRECTOR:	KIM EICHERT		FACILITY TYPE:	850
ADDRESS:	2300 HIGHWAY 166		TELEPHONE:	(661) 522-8813
CITY:	CUYAMA	STATE: CA	ZIP CODE:	93254
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	10/23/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Bertha Zendejas De Godoy		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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On 10/23/25, at 3:00 PM, Licensing Program Analyst (LPA) Matthew Sapien conducted an annual random inspection of the abovementioned Child Care Center (CCC). LPA met with Bertha Zendejas De Godoy, Site Supervisor of the CCC, and explained the purpose of the inspection. LPA toured the entirety of the the CCC (interior and exterior). The CCC uses a single classroom (Classroom #5), one bathroom, and one outdoor play area and is on the grounds of Cuyama Elementary School.

The CCC operates Monday through Friday from 7:00 AM until 2:45 PM. During the inspection, LPA observed 0 children in care and no additional staff members besides the Site Supervisor.

The classroom (Classroom 5) at the CCC is clean and orderly. The classroom has age-appropriate equipment and furnishings for children in care. The classroom contains various closets and a number of cabinets all of which contain items, equipment, and other related objects for children in care. As mentioned prior, the CCC utilizes one bathroom, which possesses three toilets and three sinks in total for children in care. The bathroom was found to be clean, orderly, and rid of any hazardous items for children in care.

The CCC possesses a mini refrigerator within the CCC's kitchen that possesses some food items and drinks for children in care. Children enjoy breakfast, lunch, and one afternoon snack, all of which is provided by the CCC). There is available drinking water for children at the CCC via a water pitcher containing filtered water and via water fountain within the classroom

CCCs constructed before 1/1/20, are supposed to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, 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 (CONT. LIC 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller, Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Maria Mueller, Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CAC - CUYAMA CENTER	FACILITY NUMBER: 421712022
	VISIT DATE: 10/23/2025

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was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Testing is valid until February of 2028.

LPA observed daily routine schedules, required notices, and other relevant licensing documents posted prominently in the classroom at the CCC. LPA also reviewed the children's sign in and sign out forms and found the arrival times of children in care from the day, along with departure times that were accurate. Children attended a scheduled field trip on today's date. LPA found that the CCC completed their most recent disaster drill on 9/26/25. Director informed LPA that the CCC conducts disaster drills every month with children in care.

LPA observed a combination carbon monoxide and a smoke detector within the classroom. The carbon monoxide and smoke detector was tested at 3:30 PM and was found to be operational. Cleaning supplies, medication lockboxes, and and sharps are stored in elevated and locked cabinets behind the teacher's desk. No children currently require medication. LPA observed multiple First Ait Kits in the CCC. The First Aid Kit was observed to contain appropriate supplies.

The outdoor playground area is enclosed by secure chain linked fencing throughout. The fence’s entry and exit gates in each of the areas are secure and furnishings in the area are age appropriate. The footing of the area is varied. The areas are made up rock pebbles, dirt, sand, concrete pavement, and natural grass. LPA observed a couple of sandboxes and water tables in the outdoor play area. LPA advised the Site Supervisor of safe practices when utilizing each. Shade is provided by a neighboring trees, building overhangs, and multiple sizable sun sails. LPA observed one large shed and two smaller sheds in the outdoor area, each of which were locked and contained child care related equipment. and a couple of buildings in the outdoor space, each of which are off-limits for children in care. Facility Representative attested to LPA that children are always supervised while outside and that the outdoor area is inspected prior to letting children outside.

A sampling of staff and children's records were reviewed. The children’s records were complete and were found to contain emergency contact information as well admission agreements, among other relevant licensing documents and forms. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) and Mandated Reporter Training certificates among other relevant licensing documents. LPA confirmed that there are no bodies of water, firearms, or ammunition that are stored on site.

LPA discussed the safe sleep regulations with Site Supervisor and discussed the Child Care Licensing Safe Sleep at (CONT. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller, Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Maria Mueller, Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: CAC - CUYAMA CENTER	FACILITY NUMBER: 421712022
	VISIT DATE: 10/23/2025

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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. This facility does not currently care for infants 24 months and under.

This facility does not currently provide Incidental Medical Services – IMS. 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 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, as specified in HSC 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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address 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.

During today's visit, no deficiencies were issued.

Facility Representative was provided with Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213). The Notice of Site Visit form must be posted for 30 days or a civil penalty of $100 may apply.

An exit interview was conducted, and the report was reviewed with Facility Representative, Bertha Zendejas De Godoy.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller, Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Maria Mueller, Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC809 (FAS) - (06/04)

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