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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215277
Report Date: 08/25/2021
Date Signed: 08/25/2021 09:42:04 AM

Document Has Been Signed on 08/25/2021 09:42 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:STUART C.GILDRED-LOS OLIVOS ELEMENTARY ENRICHMENTFACILITY NUMBER:
426215277
ADMINISTRATOR:KAYCE BUNDERSONFACILITY TYPE:
840
ADDRESS:2540 ALAMO PINTADO AVENUETELEPHONE:
(805) 686-2037
CITY:LOS OLIVOSSTATE: CAZIP CODE:
93441
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Stephanie Saucedo and Kristin ParraTIME COMPLETED:
09:50 AM
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On 8/25/2021 at 8:30 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted a Case Management Inspection - Licensee initiated for classroom change. LPA met with Department Head of Youth Program Stephanie Saucedo and Site Supervisor Kristin Parra. The Center is currently closed. School Age Program operating hours are Monday to Friday from 12:00 PM to 6:00 PM. The Center is located at Los Olivos Elementary School.

LPA, Department Head of Youth Program and Site Supervisor toured the classroom, room no. 403 and the outdoor space.
Classroom is set up for a school age environment. Water Fountain will supply drinking water inside the classroom. Elementary School play ground will be used by day care children for outdoor activities. An adequate amount of cushioning materials( wood chips) is in place under play equipment. Playground is enclosed with appropriate fence. Drinking fountain and water pitcher supply the drinking water of outdoor play area. There are nobodies of water observed. Youth Program Head stated there are no guns nor ammunition in the center.

CPR and First Aid expires on 6/3/2023. Staff met the SB 792, immunization records are on file. Staff took the AB 1207 Mandated Reporter Training on 9/25/2020. Carbon Monoxide is present Fire Clearance was granted on 8/23/2021. Licensing Required forms are posted in the bulletin board by the entrance door.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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: STUART C.GILDRED-LOS OLIVOS ELEMENTARY ENRICHMENT
FACILITY NUMBER: 426215277
VISIT DATE: 08/25/2021
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Toxins and first aid Kit are stored inaccessible to children. LPA measured the classroom and the outside activity space. Indoor area will accommodate a maximum of 21 school age children. Outdoor square footage exceeds the requirement for a total capacity of 21 children. There are 2 bathrooms designated for boys and girls with total of 4 toilets and two sinks in each bathroom.

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

Issuance of License for new classroom, room 403 is pending approval until revised LIC 200A is submitted.

Exit interview was conducted with Department Head of Youth Program and Site Supervisor. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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