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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210153
Report Date: 09/14/2022
Date Signed: 09/14/2022 04:33:32 PM


Document Has Been Signed on 09/14/2022 04:33 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:ISLA VISTA CHILDREN'S CENTERFACILITY NUMBER:
426210153
ADMINISTRATOR:ERIKA MALDONADOFACILITY TYPE:
830
ADDRESS:6842 PHELPS RD.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:27CENSUS: 9DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Serineh VartaniTIME COMPLETED:
03:45 PM
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On 9/14/22, at 3:15 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection as CCLD was informed Isla Vista Children Center at the location of 701- H West Campus Point Lane, Goleta, CA 93117 (Facility Number 426215611) merged with the abovementioned facility on 5/26/22. Additionally, the Isla Vista Children Center's 701- H West Campus Point Lane location was reportedly closed due to a shortage of staffing.

LPA met with Director Serineh Vartani and explained the nature of the inspection. LPA notes nine children are on site along with three teachers (cleared and associated) providing care and supervision.

LPA tour the interior and exterior of the CCC with the Director. LPA notes the child to staff ratio is in accordance with Title 22 and the CCC is amenable to transfer of children from the former facility. LPA notes 4 children transfer to the facility from the 701- H West Campus Point Lane location on 5/26/22. Director submitted a Request for inactive Facility Form.

No deficiencies were cited during todays visit.

A Notice of Site Visit (LIC 9213) was provided and must remain posted for 30 day.
Failure to comply with posting requirements may result in a civil penalty of $100.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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