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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426207802
Report Date: 03/07/2025
Date Signed: 03/07/2025 04:25:43 PM

Document Has Been Signed on 03/07/2025 04:25 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/
DIRECTOR:		NOHEMY ESTRADAFACILITY TYPE:
850
ADDRESS:228 NORTH I ST.TELEPHONE:
(805) 735-8392
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 19DATE:
03/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:52 PM
MET WITH:Sandy HilleTIME VISIT/
INSPECTION COMPLETED:
03:03 PM
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On 3/7/2025 Licensing Program Analysts (LPA's) German Negrete and Bill Billones made an unannounced visit for the purpose of completing a Case Management - Incident inspection. Today LPAs met with Center Site Supervisor Sandy Hille. LPAs did a walk through of the Child Care Center(CCC) with the Center Site Supervisor. LPAs observed at the time of the walk-through 19 children being supervised by 4 staff.

The purpose of the case management inspection was initiated due to multiple incidents that occurred on 2/21/2025 involving C1. CCC contacted Child Care Licensing (CCL) to self-report the following unusual incident : C2 was peddling a two passenger bike. C1 was sitting in the back of the bike. C1 wanted C2 to stop and scratched C2 left cheek. C1 left 3 marks on C2's face but at pick up time there was only 1 visible scratch left.

Today LPAs conducted children’s file review. LPAs also verified the CCC submitted LIC624 for the aforementioned incident in a timely manner.

During the departments file review LPA's discovered two additional incidents involving C1. One incident occurred on 1/15/2025, this involved C1 scratching C3. Another incident occurred on 1/13/2025, this involved C1 scratching C4's face. All three incidents are currently under review by the department.

Continued on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 426207802
VISIT DATE: 03/07/2025
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At the conclusion of the inspection LPAs requested a staff roster, children's roster and staff handbook. As well as a behavior intervention documents pertaining to C1. Exit interview conducted with the Site Supervisor Sandy Hille.

Notice of site visit was provided.

THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
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
LIC809 (FAS) - (06/04)
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