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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700341
Report Date: 11/22/2021
Date Signed: 11/22/2021 04:07:52 PM

Document Has Been Signed on 11/22/2021 04:07 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:SANTA BARBARA BRANCH - SANTA BARBARA YMCAFACILITY NUMBER:
421700341
ADMINISTRATOR:CINDY HALSTREADFACILITY TYPE:
850
ADDRESS:36 HITCHOCKTELEPHONE:
(805) 687-7727
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 19DATE:
11/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Channing HogueTIME COMPLETED:
04:15 PM
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A case management inspection was conducted by LPA S. Mendoza-Ceja who met with Director Channing Hogue.

LPA informed the Director Channing Hogue that Aaron Martinez has been excluded from working in licensed care facilities. The Director stated that Aaron Martinez is no longer working for the YMCA as of January 22, 2021.

LPA has determined that Aaron Martinez is not present or working for the YMCA.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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