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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210198
Report Date: 04/11/2024
Date Signed: 04/11/2024 09:20:00 AM

Document Has Been Signed on 04/11/2024 09:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
426210198
ADMINISTRATOR/
DIRECTOR:		SERINEH VARTANIFACILITY TYPE:
850
ADDRESS:6842 PHELPS RD.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 49DATE:
04/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Christine Broesamle TIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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On April 11, 2024 at 9:00AM, Licensing Program Analysts (LPAs) Giovani Gonzalez and Julia Meli conducted an unannounced Case Management – Other inspection at the above-mentioned Child Care Center (CCC). LPAs met with Assistant Director Christine Broesamle and informed them the purpose of the inspection is to provide the CCC with a copy of Decision and Order to exclude staff, ADAM ESCARCEGA . At the time of the inspection there were 49 children present.

LPA toured the facility and did observe Adam Escarcega present at the facility.

Respondent is prohibited for the remainder of respondent's life, from employment in, presence in, and from contact with clients of, any facility licensed by the Department or certified by a licensed foster family agency, or any resource family home, and from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, until respondent successfully petitions for reinstatement pursuant to Government Code section 11522. This Decision and Order shall become effective April 15, 2024.

The following documentation was provided and explained:

· Decision and Order - CDSS No. 6423188101

Notice of Site Visit was given. The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Assistant Director Christine Broesamle and a copy of this report was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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