Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209167
Report Date: 01/12/2017
Date Signed 01/12/2017 03:42:21 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:MEGHAN BURGERFACILITY TYPE:
840
ADDRESS:375 FERRINITELEPHONE:
(805) 781-7247
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:56CENSUS: 38DATE:
01/12/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Sharon Claggett, Director and Meghan Burger, AdministratorTIME COMPLETED:
03:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(3) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with site Director, Sharon Claggett. LPA observed 38 children in the center. The center is located in the Multi Purpose Room of Pacheco Elementary School. The center is maintained and LPA observed age appropriate games, books, art materials, tables and chairs.
There is a functioning carbon monoxide detector that meets statutory requirements. The teachers are current with CPR and First Aid. The teachers are current with immunization required per SB 792.
Sampling of children's record reviewed.
The center is providing Incidental Medical Services. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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
Ms. Claggett is current with CPR and First Aid which expires October 19, 2018. Teachers are current with immunization as required per SB 792.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

LPA observed Director 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: 01/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1