Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209167
Report Date: 08/16/2016
Date Signed 08/16/2016 02:46:50 PM

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:PACHECO ELEMENTARYFACILITY NUMBER:
406209167
ADMINISTRATOR:SHANNON JOHNSONFACILITY TYPE:
840
ADDRESS:375 FERRINITELEPHONE:
(805) 781-7247
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:56CENSUS: 0DATE:
08/16/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Meghan BurgerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Maria Mueller conducted a case management visit and met with Program Administrator, Meghan Burger. The center is located at Pacheco Elementary, and center will be using the Multipurpose Room and Music Room. The music room will only be used during rainy season and special events that Multipurpose room will be used by the school.

The program runs throughout the day:
1. 7:00 am - 8:25 am for the morning program
2. 12pm - 2:50 for Kindergarten
3. 2:50 - 6pm Sun 'N Fun program

The Multipurpose Room will also be used to serve lunch to children enrolled in the school, children will come in the morning to get breakfast and in the afternoon to get their lunch. The children leave the Multipurpose Room and eat their meals outside and are supervised by the school teachers or staff.

LPA observed age appropriate toys, games, tables and chairs. The consumer board is located in the corner of the center that is set up for the children.

The fire clearance was granted August 5, 2016 for the Multipurpose Room and the Music Room. There is a functioning carbon monoxide that meets statutory requirements. Center provides Incidental Medical Services.


Today, no deficiencies cited under Title 22 Division 12.

LPA observed Administrator post the Notice of Site Visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2016
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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