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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421711023
Report Date: 11/19/2019
Date Signed: 11/19/2019 10:19:26 AM

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:ORFALEA CHILDREN'S CENTER LAB SCHOOL AT AHCFACILITY NUMBER:
421711023
ADMINISTRATOR:MAGDALENA RAMOSFACILITY TYPE:
850
ADDRESS:800 SOUTH COLLEGE DRIVETELEPHONE:
(805) 922-6966
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:78CENSUS: 37DATE:
11/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Maria SuarezTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Melissa Stewart made an unannounced CASE MANAGEMENT inspection for the purpose of discussing a Confirmation of Removal for Evette Diaz. LPA met with Maria Suarez, Program Director and explained the purpose of the inspection. LPA toured the facility inside and out. There were 37 children supervised by 9 teachers.

On 11/19/19, Maria Suarez, Program Director submitted a Confirmation of Removal document to LPA Stewart certifying that Evette Diaz had never worked at the center.

Based on evidence obtained during today’s visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA advised Program Director to disassociate the individual from their roster.

Verification of removal is complete.

LPA observed Notice of Site Visit posted

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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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