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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700411
Report Date: 08/06/2024
Date Signed: 08/06/2024 12:50:37 PM


Document Has Been Signed on 08/06/2024 12:50 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VALLE VERDEFACILITY NUMBER:
421700411
ADMINISTRATOR:SUSAN E PONCEFACILITY TYPE:
741
ADDRESS:900 CALLE DE LOS AMIGOSTELEPHONE:
(805) 883-4193
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:547CENSUS: 329DATE:
08/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenny Firth, Director of Human ResourcesTIME COMPLETED:
01:00 PM
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On 08/06/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced case management visit to follow up on an immediate exclusion order issued 07/11/2024 for Staff #1 (S1). LPA met with Director of Human Resources Jenny Firth and explained the purpose of the visit.

LPA reviewed the facility’s fingerprint clearance roster and observed S1 was still associated to this facility as of the date of this visit. S1 had been originally associated to with the facility on 05/30/2024, and remained associated according to multiple Licensing Agency background check system(s). Director of Human Resources Jenny Firth disassociated S1 from the facility fingerprint roster during this Confirmation of Removal Case Management visit.

The Director of Human Resources stated S1 had not been physically present in the facility since 07/16/2024, the date when the exclusion order was received by the Licensee. LPA interviewed other staff in the facility who confirmed S1 had not been present recently. LPA reminded the Director of Human Resources that any further presence of S1 in the facility or interacting with clients violates the exclusion order and the facility could be subject to deficiencies and civil penalties if they do not abide by the order.

Exit interview conducted. Copy of report provided to the facility.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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