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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216660
Report Date: 12/19/2024
Date Signed: 12/19/2024 01:37:33 PM

Document Has Been Signed on 12/19/2024 01:37 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:STORYTELLER CHILDREN'S CENTERFACILITY NUMBER:
426216660
ADMINISTRATOR/
DIRECTOR:		JACQUELINE MCDONOUGHFACILITY TYPE:
830
ADDRESS:421 EAST COTA STREETTELEPHONE:
(805) 682-9585
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
12/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Natalie RobinsonTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 12/19/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced inspection for the purpose of conducting a Case Management - Incident report. LPA met with site supervisor Natalie Robinson and informed the purpose for todays inspection. Today, LPA did a walk through of the Child Care Center with the site supervisor. LPA observed at the time of the walk-through 10 infants being supervised by 4 staff.

Facility contacted Community Care Licensing (CCL) to self-report the following unusual incident : C1 was pushing the patio gate open and the gate came back and bumped C1 in the head. Then staff observed blood running down the child's nose. Staff wiped down the blood on C1's nose. C1s main teacher applied frozen teethers on the child's forehead. Staff advised parent of C1, to take C1 to C1's physician. Outside on the playground/patio at the time of the incident , there were 2 staff supervising 8 toddlers(See LIC812).

The initial phone call intake was reported to the department on 12/5/2024 by the site supervisor. The Unusual Incident Report (LIC624) was received via email and telephone on 12/5/2024. .

During todays visit LPA reviewed C1's file. LPA interviewed staff. LPA requested a copy of children roster.

Due to insufficient information at the time of the inspection LPA will continued to review and verify information. The case management incident investigation will be completed at a later time.

Exit Interview Conducted with Site Supervisor. Notice of site visit was provided.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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