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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850043
Report Date: 12/13/2024
Date Signed: 12/13/2024 12:49:54 PM

Document Has Been Signed on 12/13/2024 12:49 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PALS SANTA BARBARA AUTISM CENTERFACILITY NUMBER:
425850043
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ARNOLDFACILITY TYPE:
775
ADDRESS:5385 HOLLISTER AVE BLD9 STE215TELEPHONE:
(805) 681-1676
CITY:GOLETASTATE: CAZIP CODE:
93111
CAPACITY: 30CENSUS: 12DATE:
12/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:09 AM
MET WITH:Arnold HernandezTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Rankin visited and toured the day program today to determine if it is feasible to convert the day program into an emergency shelter when a natural disaster happens in the area. Further discussion will occur between the Regional Centers and the Department of Developmental Services. Licensee will be notified once a decision is made.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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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