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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426200008
Report Date: 08/09/2022
Date Signed: 08/09/2022 11:33:02 AM


Document Has Been Signed on 08/09/2022 11:33 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CAC - ADAM CENTERFACILITY NUMBER:
426200008
ADMINISTRATOR:STACEY LARAFACILITY TYPE:
850
ADDRESS:500 W. WINDSOR ST.TELEPHONE:
(805) 925-6667
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:24CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angelicia HernandezTIME COMPLETED:
11:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Martina Jimenez conducted a case management visit and met with Angelicia Hernandez, Site Supervisor. LPA discussed the reason for the visit. LPA was advised the center is closed due to COVID-19 exposure at a training on 8/5/2022.

LPA was informed of a COVID-19 positive staff at CAC-Little Village - 426213957, as well as a presenter at the training on 8/5/2022. The Site Supervisor contacted Ralph Ibarra, Manager. LPA completed the UIR with Ralph Ibarra, via a telephone.

Mr. Ibarra stated all CAC- center will be closed until 8/17/2022,due to COVID-19 exposure and the centers that do not reopen will be due to staffing issues. LPA advised Mr. Ibarra to submit the written UIRs for the centers closed due to COVID-19 exposure, as well as the center with the COVID-19 positive staff to CCLD.

LPA advised Mr. Ibarra to contact CCLD to advised of the centers that do not reopen on 8/17/2022.

The center was toured inside and outside. The children were not present today. LPA will return to interview children on a later day. LPA obtained a current roster of children that will not be returning to the center, with current contact information.

No citations were issued during this visit. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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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