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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203355
Report Date: 10/18/2024
Date Signed: 10/18/2024 11:16:48 AM

Document Has Been Signed on 10/18/2024 11:16 AM - 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 - J. C. WASHINGTON CENTERFACILITY NUMBER:
426203355
ADMINISTRATOR/
DIRECTOR:		SILVIA SEGOVIANOFACILITY TYPE:
850
ADDRESS:201 W. CHAPEL ST.TELEPHONE:
(805) 922-2243
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 11DATE:
10/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Molly JarvisTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 10/18/24, at 9:00 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). LPA met with Lead Teacher Nanette Bourgeios, Lead Teacher of the CCC. LPA explained the purpose and nature of the inspection. LPA toured the interior and exterior of the CCC. LPA notes the CCC's Site Supervisor, Molly Javis, arrived at the facility during the facility tour. The facility is connected to CommUnify's Administration Building. The Preschool has an AM and PM program. The AM program is from 8:00 AM to 11:30 AM, while the CCC's PM program is from 1:00 PM- 4:30 PM. The facility uses one classroom for child care services. At the time of inspection, LPA observed 11 children on site, along with two teachers (cleared and associated).

The CCC is clean and orderly. LPA observed required licensing forms and documents posted on the wall near the entry door of the CCC. LPA observed a schedule of activities sheet as well as menus posted in the CCC's classroom. LPA observed the CCC's Sign In/Out forms near the CCC's entry door.The forms contained the arrival and departure times of children in care and well as the signatures of the children's authorized representatives. The classroom has age appropriate equipment and furnishings available to children in care. The classroom is subdivided in to different learning and activity areas. The CCC has a carbon monoxide detector. The CCC's carbon monoxide detector was tested at 9:17 AM and found to be operable. The CCC uses one restroom for children in care. The restrooms is in safe and sanitary operating condition. The CCC has a kitchen on site which is inaccessible to children. LPA observed operable refrigerator's in the CCC's kitchen which stored food for children in care. The CCC provides breakfasts and lunches for children in the AM program, while children in the PM program receive lunches and snacks. The CCC also has available (filtered) drinking water for children inside and outside of the facility. CCCs constructed before 1/1/20, to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5 years after the date of the first test. For CCC 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 was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. (CONT. LIC 809, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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 - J. C. WASHINGTON CENTER
FACILITY NUMBER: 426203355
VISIT DATE: 10/18/2024
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Disinfectants, cleaning solutions and sharps are observed in secure and elevated cabinets in the CCC. Lead Teacher informed LPA no medication is on site, however when medication is on site the medication is secured in the Site Supervisor's Office which is inaccessible to children in care. The CCC has numerous First Aid kits.

The CCC outdoor playground area are enclosed by a combination of cinder block and wrought iron fencing. There is bamboo over the wrought iron fencing The fence’s entry/exit gates are secured. The surfaces of the outdoor playground area is varied. LPA observed a shed in the outdoor area which contains CCC's supplies. The shed is secured. LPA observed age appropriate play equipment in the play area. The play equipment is free of sharp, loose or pointed objects. The play structures in the outdoor playground areas have adequate cushioning materials to absorb falls and shade created by building overhangs, shade sails and trees. LPA reminded Lead Teacher and Site Supervisor to replace outdoor play equipment and furnishings when such items begin to degrade or are not in good repair. No bodies of water are observed on site.

LPA reviewed children, staff and facility records. The children’s records sampled were complete and found to contain emergency contact information and immunization records, among other required licensing documentation and forms. Staff records were reviewed. Staff records sampled were complete and found to contain First Aid/CPR certifications (EMSA approved) and Mandated Reporter Training certification, among other required licensing documentation and forms. LPA notes the last disaster drill at the facility occurred on 10/4/24. No firearms or ammunition are 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,
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 (CONT. LIC 809, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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 - J. C. WASHINGTON CENTER
FACILITY NUMBER: 426203355
VISIT DATE: 10/18/2024
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 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 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 Molly Jarvis.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC809 (FAS) - (06/04)
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