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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426211959
Report Date: 11/19/2024
Date Signed: 11/19/2024 01:51:23 PM

Document Has Been Signed on 11/19/2024 01:51 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:UNIVERSITY CHILDREN'S CENTERFACILITY NUMBER:
426211959
ADMINISTRATOR/
DIRECTOR:
ANNETTE MUSEFACILITY TYPE:
850
ADDRESS:STUDENT RESOURCE BLDG. UCSBTELEPHONE:
(805) 893-3665
CITY:SANTA BARBARASTATE: CAZIP CODE:
93106
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 21DATE:
11/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Marina NolteTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 11/19/24 at 1:45 PM Licensing Program Analysts (LPAs) Elizabeth George and Sylvia Mendoza-Ceja conducted an unannounced case management - incident follow up visit at the above mentioned address. LPAs met with Program Coordinator Marina Nolte and discussed the reason for the visit, which is a follow up for the incident reported on 10/30/24.

On 10/30/24, child 1 was running in the yard and tripped over his feet. When he tripped and fell he hit the edge of a round wooden bench, the fall cut his left eye lid open. The teacher applied direct pressure to his eye right away, then came to get program coordinator. Administrative assistant called parent to pick up, letting them know that it was a significant cut and would need medical care. Parents took to emergency room right after he was picked up. Child received 7 stitches. Child returned back to school the following week.

Based on the information gathered during the inspection, LPAs determined that the staff took appropriate action to meet the needs of the child.

No deficiencies were cited as a result of the incident.

Exit interview conducted and report was reviewed with the Program Coordinator.

A notice of site visit was given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Elizabeth George
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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