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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426210153
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:48:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2023 and conducted by Evaluator Giovani Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20231128132718
FACILITY NAME:ISLA VISTA CHILDREN'S CENTERFACILITY NUMBER:
426210153
ADMINISTRATOR:SERINEH VARTANIFACILITY TYPE:
830
ADDRESS:6842 PHELPS RD.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:27CENSUS: 15DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Serineh Vartani TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Other/Health Related Service - Staff did not immediately report injury requiring medical treatment to child's authorized representative
INVESTIGATION FINDINGS:
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On December 7, 2023 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced inspection at the abovementioned Child Care Center (CCC) to initiate a complaint investigation. LPA met with Director Serineh Vartani and informed them of the purpose of the inspection. At the time of the inspection there were 15 children present.

The Department received an allegation that staff did not immediately report injury requiring medical treatment to child’s authorized representative. LPA conducted a record review and found that the CCC self-reported an Unusual Incident Report on 11/28/2023 in which a child fell, hitting their chin, which resulted in multiple stitches. Interview with staff and Director revealed that an authorized representative of the child was not notified immediately after child received first aid and calmed down.

Based on LPAs record review and interview with the Director and staff , the preponderance of evidence
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20231128132718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426210153
VISIT DATE: 12/07/2023
NARRATIVE
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standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 Chapter 1), are being cited on the attached LIC 9099D.

During today’s inspection 1 Type B deficiency is being cited.

Exit interview was conducted and report was reviewed with Director Serineh Vartani. Notice of site visit and appeal rights were given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20231128132718
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426210153
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2023
Section Cited
CCR
101226(a)
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Health Related Services 101226(a)
(a) The licensee shall immediately notify the child's authorized representative if the child ... sustains an injury more serious than a minor cut or scratch...This requirement was not met as evidenced by
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Director agrees to submit a written statement detailing how the CCC will train staff on reporting requirements in regard to injuries sustained at the CCC, specifically regarding notifying parents of injured child. Written statement will be due 12/21/2023 via email at giovani.gonzalez@dss.ca.gov
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Interview with Director and Staff, and record review revealed that a parent was not notified immediately that child had sustained a cut that required 2 stitches.
This poses potential risk to the health, safety and personal rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3