<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426205577
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:53:13 PM


Document Has Been Signed on 03/05/2024 03:53 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 - 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: 24DATE:
03/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Alyssa FisherTIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On March 5, 2024 Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced case management- incident inspection. LPA met with site supervisor Alyssa Fisher and advised her for the purpose for the inspection. LPA was provided with a tour inside and outside of the facility. At the time of inspection there were 24 children in care of 7 staff members.

On 03/01/2024, the center contacted Community Care Licensing (CCL) to self-report an incident that occurred on 2/29/2024. The facility indicating that on 02/29/2024, a child in care (C1) indicated that a staff member (S1) hurt C1. The facility began to conduct an internal investigation and reported the incident to child welfare services (CWS).

LPA conducted interviews with staff and conducted file reviews. Staff interviewed denied ever witnessing S1 hit/hurt C1 or any other child in care. Interviews conducted determined S1 is still employed, but transferred to a different site. According to staff members, parents of C1 were advised of the incident, who did not show concern as C1 has a history of making similar allegations at home which prompt CWS visits.

LPA obtained a copy of staff's written statements made to the facilitiy's supervisor.

Based on the information gathered during the inspection, LPA determined that the center took appropriate actions to resolve the incident and no violations were made. No deficiencies were cited as a result of the incident.

Exit interview conducted and report was reviewed with site supervisor Alyssa Fisher.

A notice of site visit was given.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1