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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207378
Report Date: 03/07/2025
Date Signed: 03/07/2025 02:55:49 PM

Document Has Been Signed on 03/07/2025 02:55 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 - CHESTNUT TODDLER CENTERFACILITY NUMBER:
426207378
ADMINISTRATOR/
DIRECTOR:
MARIA CERVANTESFACILITY TYPE:
850
ADDRESS:120 W. CHESTNUT AVE.TELEPHONE:
(805) 740-4555
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
03/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Maria OrozcoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On March 7, 2025, at 2:45 PM Licensing Program Analysts (LPA) Elizabeth George conducted an unannounced Case Management Inspection. LPA met with Site Supervisor Maria Orozco and discussed the purpose of the inspection, which was to follow up on an incident reported to the Department on 2/27/25 as required. LPA in the company of the site supervisor toured the facility inside and outside. During the inspection, LPA observed 4 staff providing care to 7 children.

On February 27, 2025 at approximately 9:25 AM child was riding a tricycle when she lost her balance fell and bit her lip. The small cut required no medical attention. Parents were called and mother came to check on child. While mother was there child was clinging to mother so mother decided to take child home.

Based on the information gathered during the inspection, LPA determined that the staff took appropriate action to meet the needs of the child and other children in care.

No deficiencies were cited as a result of the incident.

A notice of site visit was given.

Exit interview conducted and report was reviewed with the Site Supervisor, Maria Orozco.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Elizabeth George
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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