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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212030
Report Date: 06/26/2024
Date Signed: 06/26/2024 03:32:22 PM

Document Has Been Signed on 06/26/2024 03:32 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:STORYTELLER CHILDREN'S CENTERFACILITY NUMBER:
426212030
ADMINISTRATOR/
DIRECTOR:		JACQUELINE MCDONOUGHFACILITY TYPE:
850
ADDRESS:2121 DE LA VINATELEPHONE:
(805) 687-4540
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 11DATE:
06/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Richard GonzalesTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On June 26, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management inspection at the above-mentioned Child Care Center (CCC). LPA met with Site Supervisor Richard Gonzales and informed the purpose of the inspection was to follow up on an incident reported on 5/31/2024. At the time of the inspection there were 11 children present.

On 5/31/2024 the CCC reported that Staff (S1) disclosed that they had witnessed Staff 2 (S2) take food away from children prior to them being finished with their meals.

LPA conducted interviews with staff. Interviews revealed that multiple staff had witnessed S2 take food away from children prior to the children being done with their meals. Interviews also revealed that it happened on a regular basis. Based on the information obtained, 1 Type B deficiency is being issued on the attached LIC809-D.

LPA notes incident is pending further review and requires further follow up.

Exit interview was conducted with Site Supervisor Richard Gonzales and notice of site visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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Document Has Been Signed on 06/26/2024 03:32 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 06/26/2024 at 01:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: STORYTELLER CHILDREN'S CENTER
FACILITY NUMBER: 426212030

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2024
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights
To be free from corporal ... or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
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CCC will submit a written statement on how they intend to prevent a similar incident from occurring again. CCC will submit statement to LPA Gonzalez via email at giovani.gonzalez@dss.ca.gov no later than 7/3/2024.
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Based on interviews conducted, S2 was removing food from children prior to children being done with there meals which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


LIC809 (FAS) - (06/04)
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