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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211744
Report Date: 10/21/2022
Date Signed: 10/21/2022 01:47:44 PM


Document Has Been Signed on 10/21/2022 01:47 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:CAC - WESTGATE CENTERFACILITY NUMBER:
426211744
ADMINISTRATOR:ADRIANA RODRIGUEZFACILITY TYPE:
850
ADDRESS:1240 W. BETHEL LN. #1ATELEPHONE:
(805) 347-8400
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:72CENSUS: 21DATE:
10/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Maribel RiosTIME COMPLETED:
02:10 PM
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On October 21, 2022 @ 1:05 PM, LPA asked staff Pre- Screening questions related to COVID-19. staff responses to the Pre-screening questions suggest no COVID-19 exposure on site.

On 10/21/2022, Licensing Program Analysts (LPAs) Martina Jimenez, and Francisco Pedroza, conducted an unannounced Case Management inspection to follow up on a report of an Unusual Incident Report (UIR) received by the Department on 10/5/2022.

LPAs met with Maribel Rios, Teacher #2, the purpose of the inspection was discussed. LPA tour the center with teacher#2, LPA observed 21 children in care at the time of inspection.

LPA spoke with Adriana Rodriguez, Site Supervisor, on the telephone in reference to the incident that occurred on 10/5/2022. The incident was found to have been appropriately handled by the center. The center will continue to monitor the behavior of all children, talking with staff, children and parents body awareness.

Based on observations and the interview with the Site Supervisor it is determined by LPA to be best categorized the incident as an accident.

There were no deficiencies cites at this time. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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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