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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421709267
Report Date: 09/05/2023
Date Signed: 09/05/2023 01:01:00 PM


Document Has Been Signed on 09/05/2023 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CAC - CORONEL CENTERFACILITY NUMBER:
421709267
ADMINISTRATOR:MARILYN I'ANSONFACILITY TYPE:
850
ADDRESS:629 CORONEL PLACETELEPHONE:
(805) 966-4552
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:38CENSUS: 7DATE:
09/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Martha Haro TIME COMPLETED:
01:00 PM
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On September 5, 2023 Licensing Program Analyst Giovani Gonzalez conducted an unannounced Case Management - Incident inspection. LPA met with Site Supervisor Martha Haro to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office via email on 7/28/23. LPA toured the facility and interviewed the Site Supervisor. At the time of inspection there were 7 children and 1 staff providing care.

On 7/28/23, the previous Site Supervisor informed CCLD that C1 got their leg stuck in between the steps of the play structure and 911 had to be called to free the child's leg.

The Site Supervisor showed LPA where the incident occurred. The Site Supervisor stated that they did not understand how the child got their foot stuck to begin with since the gap was small. LPA observed the play structure to be in good condition. The Site Supervisor stated that there has not been any other occurrences where a child got their leg stuck on the play structure however they plan on removing the the steps from the play structure to prevent it from happening again.


Given that the play structure was is in good condition, and age appropriate for the C1, no deficiencies are being issued as a result of the incident.

Notice of Site Visit was given and should remain posted for 30 days.

Exit interview was conducted and report was reviewed with Site Supervisor Martha Haro.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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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