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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703051
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:21:54 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:CDR - BENITA WALLICK HEAD STARTFACILITY NUMBER:
561703051
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2717 NORTH VENTURA AVENUETELEPHONE:
(805) 648-3083
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:40CENSUS: 0DATE:
10/16/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Maria JohnsonTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson conducted an unannounced Case Management-Legal inspection to the center. LPAs met with the Site Supervisor Maria Johnson and discussed the purpose of the inspection.

The purpose of the inspection was to review the Decision and Order CDSS No. 7819094001, Ordered September 9, 2019 and effective September 19, 2019, in regards to the denial of a criminal record exemption for Desmond Cornish, aka Desmond Henry Cornish, aka Desmond H. Cornish's. Desmond Cornish may not re-apply for a criminal record exemption for a period of two (2) years from the effective date of this decision.

LPAs have determined Desmond Cornish is not employed or present in any facility.


No deficiencies cited.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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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