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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421712020
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:15:02 PM

Document Has Been Signed on 02/27/2025 12:15 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAC - SIERRA MADRE CENTERFACILITY NUMBER:
421712020
ADMINISTRATOR/
DIRECTOR:		CASSANDRA HARTFACILITY TYPE:
850
ADDRESS:1002 E. SIERRA MADRE AVE.TELEPHONE:
(805) 349-9707
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 5DATE:
02/27/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:Susana Del Toro, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On February 27, 2025 Licensing Program Analysts (LPAs) Bill Billones and Elizabeth George conducted an unannounced case management incident inspection. LPAs met with site supervisor Susana Del Toro and informed them the purpose of the inspection was to follow up on an incident reported to the Department on February 21, 2025 as required. LPAs were escorted through the facility and toured the inside and outside. During the inspection, LPAs observed 2 staff providing care to 5 children.

On February 21, 2025, at approximately 9:35 AM, teacher witnessed and heard child 1 trip over their two feet, fall, and hit their forehead on the cement ground. Teacher states child 1 receives occupational therapy services, which explains why child 1 didn't immediately react by placing their hands in front of them to break the fall. Teacher noticed a goose egg bump on the forehead of child 1 and called for assistance, and then proceeded to place ice on the forehead of child 1. Teacher then called 911 and waited for the paramedics to arrive. Site supervisor was also immediately notified who then informed the child's mother. Teacher states the child was feeling lethargic and tried to keep them alert and awake. Paramedics arrived and teacher went in ambulance to accompany child per request of paramedics because parent was not immediately available. Site Supervisor followed paramedics to ER to pick up teacher and return to center. Child 1 was medically discharged and went home with parent the same day. Child 1 returned to the center for full day on February 25, 2025. At the time of incident there were a total of 3 children being cared for with 2 staff present and another fully qualified infant teacher was immediately available to supervise the children that remained in the classroom. Site supervisor obtained a medical report on February 25, 2025, which was reviewed by LPAs during site visit.

Based on the information gathered during the inspection, LPAs determined that the site supervisor took appropriate action to meet the needs of child 1 and other children in care.

No deficiencies were cited as a result of the incident.

Exit interview conducted and report was reviewed with the site supervisor.

A Notice of Site Visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Bill-Brian Billones
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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