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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703051
Report Date: 02/12/2026
Date Signed: 02/12/2026 12:03:28 PM

Document Has Been Signed on 02/12/2026 12:03 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:CDR - BENITA WALLICK HEAD STARTFACILITY NUMBER:
561703051
ADMINISTRATOR/
DIRECTOR:		SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2717 NORTH VENTURA AVENUETELEPHONE:
(805) 648-3083
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 38DATE:
02/12/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Megan Ramsey TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On February 12, 2026, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Incident inspection at the above mentioned Child Care Center (CCC). LPA met with Site Supervisor Megan Ramsey and informed them the purpose of the inspection. At the time of the inspection 36 children and 6 staff were present.

On 2/3/26, the CCC self reported an incident where Staff 1 (S1) and (S2) took their classroom to the play ground, unaware they left Child 1 (C1) in the classroom. Staff 3 (S3) walked by the classroom and observed C1 was left unattended.

LPA in the company of the Site Supervisor, toured the area where the incident occurred. LPA observed the exit gated were secured. Further LPA observed the classroom to have age appropriate toys and furnishings. LPA reviewed statements made by S1, S2 and S3 and noted C1 was left unattended for approximately 3 minutes.

LPA notes the facility has reviewed procedures with staff in order to prevent a similar incidents from occurring. Additionally, the facility responded appropriately in reporting the incident to Licensing and informing parent of C1.

Based on the information obtained, 1 Type B deficiency is being issued as a result of the incident on the attached LIC 809D.

Report was reviewed with Site Supervisor Megan Ramsey. Notice of site visit and appeal rights were given.
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 02/12/2026 12:03 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 02/12/2026 at 11:17 AM
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: CDR - BENITA WALLICK HEAD START
FACILITY NUMBER: 561703051

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision

(1) No child(ren) shall be left without the supervision of a teacher at any time, ... Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Facility has taken the following steps: met with the staff after class and together reviewed Procedure ECE 106 Active Supervision and ECE 101 Teaching and the Learning Environment as well as the Active Supervision Log. Documenting on the Active Supervision log was discussed and reviwed as well as utilizing the number rings in the classroom and on the playground to assure accurate counting of the children at all times.
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Based on interview and record review, facility did not comply with the deficiency cited above which poses an a potential risk to the health, safety and or personal rights of 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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Giovani Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2026


LIC809 (FAS) - (06/04)
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