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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426205725
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:33:49 PM

Document Has Been Signed on 09/01/2022 03:33 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 - BONITA MIGRANT AND SEASONAL HEAD STARTFACILITY NUMBER:
426205725
ADMINISTRATOR:A.RAMIREZ-BARRONFACILITY TYPE:
850
ADDRESS:4685 EAST 11TH STREETTELEPHONE:
(805) 343-0324
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY: 40TOTAL ENROLLED CHILDREN: 20CENSUS: 9DATE:
09/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Pamela PanoTIME COMPLETED:
04:21 PM
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On September 1, 2022 at 3:10 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management – COVID-19 inspection and met with, Pamela Pano, Site Supervisor.

LPA informed the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. The Site Supervisor gave LPA a tour of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL between August 23, 2022 - August 26, 2022. CCL provided a Tele - Rapid Assistance Support Team (RAST) inspection on April 1, 2021, where LPA provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA observed facility staff wearing masks upon arrival to the facility. The children in care were playing indoors during this inspection.

This report continues on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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 - BONITA MIGRANT AND SEASONAL HEAD START
FACILITY NUMBER: 426205725
VISIT DATE: 09/01/2022
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LPA discussed facility’s written plan for when a staff member or child tests positive for COVID-19 and developing a written communication plan with parents/guardians to share information and guidelines in their preferred language.

LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand-washing, Food Service and Meal Times.

LPA reviewed that facility maintains a current Covid-19 Child Care Program Self-Assessment Guide/Mitigation plan. LPA also provided the following resources:

- Official Public Health and Child Care Guidance for COVID-19 – Updated 1/26/2022.

- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Site Supervisor, Pamela Pano.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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