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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207802
Report Date: 01/10/2024
Date Signed: 01/10/2024 01:07:12 PM

Document Has Been Signed on 01/10/2024 01:07 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 - "I" STREET CENTERFACILITY NUMBER:
426207802
ADMINISTRATOR:NOHEMY ESTRADAFACILITY TYPE:
850
ADDRESS:228 NORTH I ST.TELEPHONE:
(805) 735-8392
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 17DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Shonna MartinTIME COMPLETED:
01:21 PM
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On January 10, 2024, Licensing Program Analyst's (LPA's) Susana Martinez and German Negrete conducted an unannounced Case Management- Incident inspection. LPA's met with Site Supervisor Shonna Martin and advised her the purpose of the inspection. LPA's toured the facility inside and out. At the time of inspection there were 17 children and 3 staff.

On 12/11/2023, Site Supervisor Shonna Martin contacted Community Care Licensing (CCL) to self-report an incident of a parent stating a child (C1) said that a staff member (S1) allegedly grabbed the child by the arm, which caused a bruise. Parent also informed supervisor that C1 observed S1 hit another child. Site supervisor contacted the Lompoc Police Department to file a report.

LPA Negrete requested Police Records from the Lompoc Police Department pertaining to this incident.

Interviews determined, (S1) was placed on administrative leave on 12/11/2023, after informing S1 of the allegation. Site Supervisor stated that HR personnel, Monica Morena conducted investigation and has further information. LPA Martinez contacted Monica via telephone. Monica determined that S1 could return to work after conducting an internal investigation. Monica Moreno states the employee returned to work on 12/18/2023. Monica also states the Police Department did not follow up afterwards.

Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate. The facility acknowledged they are being transparent and ensuring the safety of the children in their care.
No deficiencies were issued.
A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Shonna Martin.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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