426200008-9-3-2024-17-CC-MJIZ-D8RV26-20240903160236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426200008
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:02:45 PM

Document Has Been Signed on 09/03/2024 04:02 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:	CAC - ADAM CENTER		FACILITY NUMBER:	426200008
ADMINISTRATOR/ DIRECTOR:	STACEY LARA		FACILITY TYPE:	850
ADDRESS:	500 W. WINDSOR ST.		TELEPHONE:	(805) 925-6667
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 7	DATE:	09/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:40 PM
MET WITH:	Gina Martinez		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 9/3/2024, Licensing Program Analyst (LPA) Martina Jimenez and Shane Loftus, conducted an unannounced Annual/Random Inspection of Adam Child Care Center (CCC). LPA met with Gina Martinez, Site Supervisor of the CCC and explained the purpose of the inspection. LPAs, along with the Site Supervisor toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 5:30 PM, Monday-Friday. LPA observed 7 children napping, along with 3 staff members (cleared and associated) providing care and supervision. The CCC operates out of one classroom. LPAs notes the CCC is a preschool program. LPAs observed age appropriate toys and furnishings throughout the CCC. Toys include auditory, visual and tactile stimulation items as well as items to enhance and manipulative skills. LPAs observed the CCC to have napping cots for children. LPAs observed the sign-in sign-out sheet to be completed. LPAs observed a carbon monoxide detector in the CCC. Per the center's log the carbon monoxide detector was tested on 10/31/2022, and found to be operable. The CCC has an operable refrigerators in the kitchen. The refrigerator contains food items and beverages for the children's consumption. The refrigerator has excess food items provided to children. There is available drinking water both inside the classroom and outside in the play area. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child-Care Centers (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 childcare 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. Continues on LIC809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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: CAC - ADAM CENTER	FACILITY NUMBER: 426200008
	VISIT DATE: 09/03/2024

NARRATIVE

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Disinfectants and cleaning solutions, and sharps are located in a secured elevated locations and inaccessible to children. Required licensing forms and documents are posted in each classroom and in the entrance of the center. The restrooms in the CCC are in clean and sanitary operating condition.

The CCC's outdoor playground areas are enclosed by chain link fencing. The fence’s entry/exit gates are secured. The footing in the area is varied. LPAs observed age-appropriate toys/play equipment in the play area which are in suitable condition. LPAs observed play structures in the playground areas to have adequate cushioning materials to absorb falls. LPAs also observed ample shade in the play areas. No bodies of water were observed on site. LPAs observed waste receptacles with tight fitting covers throughout the CCC.

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 immunization records, among other required licensing documents. All three staff files were either incomplete or there was no file available at the time of the inspection. Site Supervisor noted no firearm or ammunition is stored on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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.

LPAs discussed the safe sleep regulations with Facility Representative and discussed the Child-Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resources.

Continues on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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: CAC - ADAM CENTER	FACILITY NUMBER: 426200008
	VISIT DATE: 09/03/2024

NARRATIVE

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LPAs 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.

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

Today, deficiency cited under Title 22 Division 12 Appeal rights given. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor, Gina Martinez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/03/2024 04:02 PM - It Cannot Be Edited

Created By: Martina Jimenez On 09/03/2024 at 03:30 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CAC - ADAM CENTER	FACILITY NUMBER: 426200008
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation, interview with Site Supervisor and record review, revealed all three staff files were either incomplete or there was no file available at the time of the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/10/2024
	Plan of Correction
1 2 3 4	The Site Supervisor will submit verification of the three staff completed files to CCLD by 9/10/2024, via email to: shane.loftus@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Maria Mueller

LICENSING EVALUATOR NAME:

Martina Jimenez

LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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