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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702142
Report Date: 08/16/2024
Date Signed: 08/16/2024 02:48:56 PM

Document Has Been Signed on 08/16/2024 02:48 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CAC - GOLETA II CENTERFACILITY NUMBER:
421702142
ADMINISTRATOR/
DIRECTOR:		NEENAN, LORRAINEFACILITY TYPE:
850
ADDRESS:5681 HOLLISTER AVENUETELEPHONE:
(805) 967-3637
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Susana Del ToroTIME VISIT/
INSPECTION COMPLETED:
02:09 PM
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On 08/16/2024, Licensing Program Analysts (LPAs) German Negrete and Sylvia ceja 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 Site Supervisor Susana Del Toro and explained the purpose of the visit. LPAs reviewed the facility’s fingerprint clearance roster and observed S1 is no longer associated to this facility as 07/16/2024. S1 had been originally associated to/with the facility on 01/11/2023 and remained associated until 07/16/2024 , according to Care provider management branch. During the inspection LPAs observed 0 children and 2 staff..

The site supervisor stated S1 had not been physically present in the facility since 12/31/2023. LPAs interviewed other staff in the facility who confirmed S1 had not been present recently. LPA reminded the site supervisor 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.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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