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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426205577
Report Date: 01/29/2020
Date Signed: 01/29/2020 12:42:04 PM

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 - FILLMORE CENTERFACILITY NUMBER:
426205577
ADMINISTRATOR:SHONNA MARTINFACILITY TYPE:
850
ADDRESS:1316 E. OAK ST.TELEPHONE:
(805) 736-2811
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:45CENSUS: 29DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Shonna Martin and Maria DouviaTIME COMPLETED:
11:20 AM
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A case management inspection was conducted by LPA S. Mendoza-Ceja who met with Site Supervisor Shonna Martina and Program Manager Maria Douvia regarding incidents that were reported to the Department as required.

The incidents were reviewed for January 2020 (3 incidents), December 2019 (1 incident), including November 2019 (1 incident) in regards to biting incidents that have occurred at the center. Review of incidents revealed child #1 has bitten children while in care at the center; however, none of the bites resulted in broken skin. The parents of the children involved in the incidents were contacted by telephone and provided an ouch report regarding the biting. The Site Supervisor stated she has discussed and provided handouts to parents about why children bite. Site Supervisor also stated she has also discussed biting with staff and the children in care. The Site Supervisor stated staff are shadowing child #1 and are reducing the class size and ratio to two teachers supervising 12 children. Further review of the incidents revealed the center was in compliance with teacher child ratios when the incidents occurred.

The Program Manager and the Site Supervisor stated they are currently working with the family of child #1 and child #1 to meet the child's needs and needs of all the children in care. The Program Manager stated she will be having an additional staff to be working directly with child #1.

LPA reviewed children's files which revealed child #1 has behavioral intervention plan in place. LPA was advised family/child #1 has been referred to the family wellness program for additional support. LPA was also informed the center is also reaching out to other local agencies to obtain additional services for child #1.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100 CIVIL PENALTY.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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