Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209596
Report Date: 01/11/2019
Date Signed 01/11/2019 01:38:21 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:EL CAMINO SCHOOLFACILITY NUMBER:
426209596
ADMINISTRATOR:SARAH BAUTISTAFACILITY TYPE:
850
ADDRESS:5020 SAN SIMEONTELEPHONE:
(805) 692-5574
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:24CENSUS: 19DATE:
01/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Joeana JiminezTIME COMPLETED:
01:40 PM
NARRATIVE
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An annual review was conducted by LPA S. Mendoza-Ceja who met with Joeana Jiminez and Liz Barnitz who arrived during the visit. The center was toured inside and outside. The preschool operates Monday – Friday, 8:00 AM - 12:00 PM. LPA reviewed the medication which is maintained in the school office. The classroom was observed to be clean and orderly. The menu was posted for review. The food is prepared at the Goleta Union School District Cafeteria. LPA reviewed the handout “A Child Care Provider’s Guide to Safe Sleep”. There is carbon monoxide detector in the classroom. The restrooms was observed to clean. The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records. Staff records were reviewed. LPA reviewed current CPR and First Aid for Joeana Jiminez. LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised, each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or obtain a sign statement declining the influenza vaccination. LPA also reviewed the requirement of the AB 1207 Child Mandated Reporter Training for staff.
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

The following Type B deficiencies are cited according to CCR, Title 22, Divsion12 in regards to records.


Due to computer malfunction report was mailed.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: EL CAMINO SCHOOL
FACILITY NUMBER: 426209596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2019
Section Cited
CCR
101216(g)
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101216(g) Personnel Requirements. All personnel including the licensee shall have a health-screening report, including specified information, signed by the person who performed it. A statement signed by each volunteer affirming that he/she is in good health. Results of a test for TB performed not more than 1 year prior to or seven days after initial presence in the center (volunteer).
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Please submit verification to the Department by 02/11/2019
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The above regulation was not met as evidenced by failure to ensure physicals were completed for staff/including substitutes. In addition, to not obtaining statements of good health for volunteers, including TB clearances which poses a potential risk to the safety of the children
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Type B
02/11/2019
Section Cited
HSC
1596.7995(a)(1)
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1596.7995 (a)(1)Health & Safety Commencing 09/01/2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between Aug.1 and Dec. 1 of each year.
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Please submit verification to the Department for review by 02/11/2019.
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The above regulation was not met as evidenced by failure to obtain verification of immunizations for substitute staff and volunteers which poses a potential risk to the safety of the children
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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 MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: EL CAMINO SCHOOL
FACILITY NUMBER: 426209596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2019
Section Cited
HSC
1596.8662(b)(1)
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1596.8662(b)(1) Health and Safety
On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training ... every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Please submit verification to Licensing for review by 02/11/2019.
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Based on review of records revealed verification was not available for all staff for completetion of the mandated reporter training AB1207 which poses a potential risk to health and safety of children in care.
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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 MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2019
LIC809 (FAS) - (06/04)
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