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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709978
Report Date: 05/04/2026
Date Signed: 05/04/2026 10:44:30 AM

Document Has Been Signed on 05/04/2026 10:44 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MOUNT CROSS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
561709978
ADMINISTRATOR/
DIRECTOR:		AMY VEGAFACILITY TYPE:
850
ADDRESS:102 CAMINO ESPLENDIDOTELEPHONE:
(805) 482-9706
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 57DATE:
05/04/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Elizabeth FoxTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
NARRATIVE
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On 05/04/2026, Licensing Program Analyst (LPA) Shane Loftus conducted an unannounced Case Management inspection of the above-mentioned Child Care Center (CCC) to follow up on an Unusual Incident Report (UIR) received by the Department on 04/07/2026. Specifically, a child in care (C1) vomited and was on the verge of losing consciousness. LPA met with CCC Assistant Director Elizabeth Fox and explained the nature of the inspection. LPA notes fifty-six (56) children are on site along with eleven (11) staff providing care and supervision.

Assistant Director and LPA viewed the area where the incident occurred. LPA notes the incident took place in the PLC (Parish Life Center) Classroom. LPA notes the classroom has age-appropriate toys and furnishings and is free of hazards. Assistant Director informed LPA that the incident occurred on 03/31/2026 at 8:17 am during story time. The Assistant Director noticed C1 started to burp which led to C1 vomiting. The Assistant Director then noticed C1’s eyes roll back and C1’s body became limp. S1 was present during the incident and tended to C1 while the Assistant Director called paramedics. C1’s parents were immediately notified and arrived at the CCC shortly after the paramedics arrived. A1 rode in the ambulance with C1 to the Emergency Room. The Assistant Director informed LPA that C1 has had no prolonged issues from the incident and returned to the CCC on 04/27/2026. LPA notes the time between the incident and C1 returning to the CCC is not related to the incident. LPA confirms the Assistant Director’s account of the incident corroborates the UIR submitted to Community Care Licensing (CCLD). LPA’s interview with the Assistant Director found that the incident occurred on 03/31/2026, and the CCC did not inform CCLD until 04/03/2026. Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Shane Loftus
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2026
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MOUNT CROSS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 561709978
VISIT DATE: 05/04/2026
NARRATIVE
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Based on records review and interview, a Type B deficiency is being cited in accordance with Title 22 of the California Code of Regulations. Please refer to LIC 809 D for documentation of deficiency cited.

A notice of site visit was given and must remain posted for 30 days as required by H&S Code Sec.1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Shane Loftus
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/04/2026 10:44 AM - It Cannot Be Edited


Created By: Shane Loftus On 05/04/2026 at 10:29 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: MOUNT CROSS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 561709978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2026
Section Cited
CCR
101212(d)(1)(B)

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101212 Reporting Requirements(d)Upon the occurrence, during the operation of the child care center…a report shall be made to the Department…within the Department's next working day…following the occurrence of such event.
(1) Events reported shall include...(B) Any injury...that requires medical treatment.
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Licensee will submit a written statement explaining their understanding of CCC Reporting Requirements regulation 101212, and how they will ensure this regulation will not be violated moving forward. Licensee will submit the written statement to CCLD (shane.loftus@dss.ca.gov) by 05/18/2026.
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This requirement was not met as evidenced by: Based on records review and interview, the unusual incident occurred on 03/31/2026 and was not reported to CCLD until 04/03/2026. This 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.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Shane Loftus
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2026


LIC809 (FAS) - (06/04)
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