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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710362
Report Date: 05/08/2024
Date Signed: 05/08/2024 03:27:43 PM

Document Has Been Signed on 05/08/2024 03:27 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:OAKS PARENT CHILD WORKSHOPFACILITY NUMBER:
421710362
ADMINISTRATOR/
DIRECTOR:		EMBRY, THERESAFACILITY TYPE:
850
ADDRESS:605 W. JUNIPERO ST.TELEPHONE:
(805) 682-7609
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 11DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Theresa Embly TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On May, 8 2024, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Incident inspection at the abovementioned Child Care Center (CCC). LPA met with Director Theresa Embry and informed them the purpose of the inspection. At the time of the inspection there were 11 children present and 2 staff providing care.

On 5/3/2024 the Director contacted Community Care Licensing (CCL) to self report an incident where Child 1 (C1) was playing in the sand, ran towards a table, and bent down, subsequently hitting their head on the table. C1 struck their right eye brow on the corner of the table. C1 received a small cut on his right eye brow. Parents were contacted of the incident. Parents then picked up child and took them to urgent care where C1 received 3 stitches.

LPA toured the facility in the company of the Director. LPA observed the area where the incident occurred and notes that the table is age appropriate to children in care. LPA did not observe any hazards that could have caused the incident to occur. LPA interviewed the Director as well. The Director stated that the incident was observed by Staff 2 (S2) . Director also stated that the child came back the next day and that parents were understanding of the incident.

Additional information is needed to conclude the Case Management - Incident. Report was reviewed with Director Theresa Embry and copy was provided. Notice of site visit was given
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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