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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702142
Report Date: 09/05/2023
Date Signed: 09/05/2023 04:32:35 PM

Document Has Been Signed on 09/05/2023 04:32 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 - GOLETA II CENTERFACILITY NUMBER:
421702142
ADMINISTRATOR:NEENAN, LORRAINEFACILITY TYPE:
850
ADDRESS:5681 HOLLISTER AVENUETELEPHONE:
(805) 967-3637
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
09/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Monica Moreno TIME COMPLETED:
01:44 PM
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On September 5th, 2023, at 1:09PM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Case Management visit for the purposes of file review. The visit was not conducted at the licensed Child Care Center but in the Office of Human Resources located at 5638 Hollister Ave # 230, Goleta, CA 93117.

LPA met with Monica Morena, Human Resources (HR) director and was provided all documents requested by the Department.

Exit interview conducted, report reviewed, and signed by HR director.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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