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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212168
Report Date: 05/16/2024
Date Signed: 05/16/2024 11:49:13 AM

Document Has Been Signed on 05/16/2024 11:49 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CDR - FILLMORE HEAD STARTFACILITY NUMBER:
566212168
ADMINISTRATOR/
DIRECTOR:		SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:615 SHIELS DR.TELEPHONE:
(805) 432-2068
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
05/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Christy DeoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On May 16, 2024 at 9:10, Licensing Program Analyst (LPA) Veronica Diaz conducted an unannounced Required 3 Year inspection. LPA met with site supervisor Christy Deo and advised them of the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 16 children in care at the time of the inspection along with 3 staff.

Prior to entering facility LPA observed a child crying behind the secured gate in the play area, siting on a child picnic table LPA did not observe any staff in sight. The door was slightly open, LPA asked the child were is their teacher and they just pointed towards the door and continued to cry. LPA began to yell out "hello, excuse me anyone" LPA called out a few times and no answer and no staff came out. LPA called the number on the profile sheet and it is no longer in service. At about 9:25 LPA observed a staff entering the preschool gate and advised them that I am with licensing and there is a child crying unattended outside in the play area sitting on a picnic bench. Staff walked over to take a look stated the teacher is by the door and let me into the secured preschool.

LPA observed required licensing documents mounted on the walls throughout the facility. Last fire drill was conducted on 04/24/24. The classroom has age-appropriate toys and furniture readily accessible for children in care. LPA observed enough toilettes and sinks available for children to use. LPA did not observe any hazards/toxins items accessible to children. First Aid kits were observed throughout the facility. Facility provides morning, afternoon snacks, and Lunch.


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SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/16/2024 11:49 AM - It Cannot Be Edited


Created By: Veronica Diaz On 05/16/2024 at 10:58 AM
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: CDR - FILLMORE HEAD START
FACILITY NUMBER: 566212168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2024
Plan of Correction
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Site Supervisor will write up a plan and submit it by email to LPA
Also remind staff about child should not be left alone at anytime.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:George Mingle
LICENSING EVALUATOR NAME:Veronica Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CDR - FILLMORE HEAD START
FACILITY NUMBER: 566212168
VISIT DATE: 05/16/2024
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The outdoor playground is shaded and has an ample amount of space for children to play. LPA observed the playground has age-appropriate toys and structures available for children to use.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Staff mandated reporter certification are all current. CPR/First Aid for staff are current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements.

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.

Site Supervisor 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.

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 child care 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. CCC COMPLETED TESTING

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SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CDR - FILLMORE HEAD START
FACILITY NUMBER: 566212168
VISIT DATE: 05/16/2024
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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/.


Site Suervisor 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.

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 Christy Deo. 1 type B deficiencies were cited.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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