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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702142
Report Date: 04/11/2024
Date Signed: 04/11/2024 10:14:18 AM


Document Has Been Signed on 04/11/2024 10:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 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:38CENSUS: 3DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Susana Del Toro TIME COMPLETED:
10:30 AM
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On April 11, 2024 at 9:45AM, Licensing Program Analysts (LPAs) Giovani Gonzalez and Julia Meli conducted an unannounced Case Management – Other inspection at the abovementioned Child Care Center (CCC). LPAs met with Site Supervisor Susana Del Toro and informed them the purpose of the inspection is to provide the CCC with a copy of Decision and Order to exclude staff, ADAM ESCARCEGA . At the time of the inspection there were 3 children present.

LPA toured the facility and did not observe Adam Escarcega present at the facility. The Site Supervisor stated that Adam Escarcega has not worked at this CCC since June of 2022.

Respondent is prohibited for the remainder of respondent's life, from employment in, presence in, and from contact with clients of, any facility licensed by the Department or certified by a licensed foster family agency, or any resource family home, and from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, until respondent successfully petitions for reinstatement pursuant to Government Code section 11522. This Decision and Order shall become effective April 15, 2024.

The following documentation was provided and explained:

· Decision and Order - CDSS No. 6423188101

Notice of Site Visit was given. The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Site Supervisor Susana Del Toro and a copy of this report was given.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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