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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 09:32:57 AM

Document Has Been Signed on 02/27/2025 09:32 AM - 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: 30DATE:
02/27/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Adriana RodriguezTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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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 Adriana Rodriguez and discussed the purpose of the inspection, which was to follow up on an incident reported to the Department on 2/21/25. LPAs along with site supervisor toured the facility inside and outside. During the inspection there were 30 children in the care of 6 staff.

Summary of UIR states that Child 1 and Child 2 were playing with blocks and during clean up Child 2 threw a block at Child 1. The student teacher may have hit Child 2 and/or showed Child 2 how to throw a block.



Site supervisor states that the student teacher was showing child 2 how a block felt when it hit their head and tapped the block against child 2s head. Child 2 was stunned by the interaction. Assistant Teacher took over the transition with the children from play to lunch and explained the incident to site supervisor. Site supervisor spoke with the student teacher privately about the incident. Student teacher is still new to the program, her third day working, and still within her general new hire training. Site supervisor explained the student teacher has specific duties of cleaning up before and after meals and lunch along with observation of everything. CAC continues to lend guidance and support to student teacher and they will continue to receive training. Child 2s mother requested to have student teacher removed from facility. Student teacher is no longer at this facility and has been given other options to continue at other CAC locations.

Based on the information gathered during the inspection, LPAs determined Sierra Madre Center took appropriate action to meet the needs of both children in care and support/ training of staff.

During the inspection site supervisor provided the LIC624.

No deficiencies were cited as a result of the incident.

A Notice of Site Visit was given, exit interview conducted and report was reviewed with Site Supervisor, Adriana Rodriguez.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Elizabeth George
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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