Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209596
Report Date: 04/07/2016
Date Signed 04/07/2016 12:35:17 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:EL CAMINO SCHOOLFACILITY NUMBER:
426209596
ADMINISTRATOR:LIZ BARNITZFACILITY TYPE:
850
ADDRESS:5020 SAN SIMEONTELEPHONE:
(805) 692-5574
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:24CENSUS: 18DATE:
04/07/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Joenna JimenezTIME COMPLETED:
12:45 PM
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(3) Licensing Program Analyst (LPA) Maria Mueller conducted an annual random visit and met with Site Supervisor, Joenna Jimenez. LPA informed Ms. Jimenez the reason for the visit. The center is located in room #2 at El Camino Elementary School. The center operates 8:15 am until 12:00 pm Monday to Friday.

The classroom is clean and free of toxins. No toxins or hazardous materials observed. LPA observed age appropriate toys, games, books, tables and chairs. There are no medications stored in the classroom.
LPA observed 2 storage shed of additional toys, bikes and umbrellas for shade.

The bathroom is located outside of the classroom. Children are escorted to and from the bathroom.

Children's record reviewed. Staff files reviewed.

Ms. Jimenez is current with CPR and First Aid which expires February 22, 2018.



Today, no deficiencies cited under Title 22 Division 12.







LPA observed Ms. Jimenez 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: 04/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2016
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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