Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406209167
Report Date: 03/22/2018
Date Signed 03/22/2018 03:48:21 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: 31DATE:
03/22/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Michelle Rolle, Recreation CoordinatorTIME COMPLETED:
04:00 PM
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(2) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with Recreation Coordinator, Micheller Rolle. The center is located at the Multi Purpose room at Pacheco Elementary School. The center operates Monday, Tuesday And Wednesday 7:00 am to 8:30 am and 2:50 pm to 6:00 pm. On Thursday and Friday the center operates 7:00 am to 8:30 am and 12:00 pm to 6:00 pm.
The classroom is clean with age appropriate tables, chairs, reading area, and art materials. When multipurpose room is used, the children are using the stage area and music area of the school.
LPA observed 31 children with 4 teachers and 1 aide. Teachers are current with immunization requirements per SB 792. Teachers are scheduled to take the Mandated Child Abuse Reporting training per AB 1207. There is a functioning carbon monoxide detector that meets statutory requirements.

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

Teachers are current with CPR and First Aid which expires October 19, 2019.

In areas evaluated, no deficiencies observed.

LPA observed Ms. Rolle 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: 03/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2018
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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