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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426206184
Report Date: 06/07/2023
Date Signed: 06/07/2023 05:19:48 PM

Document Has Been Signed on 06/07/2023 05:19 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:LOMPOC BRANCH - LOS BERROSFACILITY NUMBER:
426206184
ADMINISTRATOR:SAUCEDO, STEPHANIEFACILITY TYPE:
840
ADDRESS:3745 VIA LATOTELEPHONE:
(805) 733-5530
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 19DATE:
06/07/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Luz NicacioTIME COMPLETED:
05:30 PM
NARRATIVE
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On 6/7/23, at 3:30 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random inspection of the abovementioned Child Care Center (CCC). LPA met with Luz Nicacio, 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 is located in a module classroom on the grounds Los Berros Elementary School. The CCC has an AM program on site from 7:00 AM to 8:05 AM and a PM program on site from 2:20 PM to 6:00 PM Monday-Tuesday and Thursday-Friday. On Wednesday the CCC's PM program is from 12:00 PM to 6:00 PM. LPA observed 19 children in care during the inspection along with two teacher (cleared and associated) providing care and supervision. LPA notes Site Supervisor assist with the care and supervision of children on site.

LPA reviewed the CCC's Sign In/Out forms for children at the entry of the classroom and notes the forms contain the children's arrival and exit times as well as the signature of the children's authorized representatives. LPA observed required licensing notices and documents posted along the wall of the CCC.
The CCC classroom has age appropriate equipment and furnishings available to children in care. The CCC's carbon monoxide detector is intergraded in the facility's fire system. The restrooms used by the children in care are in safe and sanitary operating condition. The restrooms are detached from the CCC and staff members escort children to use the restrooms. LPA observed an operable refrigerator in the classroom which contains food for the children's consumption. The CCC provides an afternoon snacks for the children and LPA observed a CCC menu posted in the classroom. Children have available drinking water inside of the CCC and outside in the form of filtered water. The classroom has no water source and the filtered water from the school has been tested for lead containment levels. Disinfectants, cleaning solutions, medications and sharps are secured behind the classroom's teachers desk which is inaccessible to children and excluded from care.

The CCC uses the elementary school's rear blacktop for outdoor activities. The area is enclosed within the
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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: LOMPOC BRANCH - LOS BERROS
FACILITY NUMBER: 426206184
VISIT DATE: 06/07/2023
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elementary school but not self enclosed. Site supervisor is reminded to ensure children in care are directly supervised when engaged in outdoor activities in the area. LPA did not observe any bodies of water on site.

A sampling of staff and children's records are reviewed. The children’s records are complete and found to contain emergency contact information and admission agreements. Staff records are reviewed and contained documentation to support their educational training and experience. LPA also observed current pediatric CPR/ First Aid (EMSA approved) certifications along with Mandated Reporter training certifications. Site Supervisor notes no firearm or ammunition is stored on site.

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.

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 Luz Nicacio

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

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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