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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561711699
Report Date: 05/14/2025
Date Signed: 05/14/2025 01:55:32 PM

Document Has Been Signed on 05/14/2025 01:55 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:CROSS ROADS CHILDREN'S CENTERFACILITY NUMBER:
561711699
ADMINISTRATOR/
DIRECTOR:		MICHELLE GORDONFACILITY TYPE:
850
ADDRESS:2372 ERRINGER ROADTELEPHONE:
(805) 526-2887
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 64DATE:
05/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Michelle GordonTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On May 14, 2025 at 12:05 PM Licensing Program Analyst (LPA) Laura Carone conducted an unannounced inspection to conduct a Case Management-incident visit. LPA met with Director, Michelle Gordon and explained the purpose of the visit. LPA conducted a tour of the facility inside and outside with Director. LPA observed a total of 64 children under the care and supervision of 11 staff. There are 7 preschool classrooms.

On April 10, 2025, Director, Michelle Gordon reported an incident that occurred on March 27, 2025 involving C1. Director stated that she thought she had emailed the written unusual incident report LIC624. Director noticed the report was in the emails drafts and was not sent to Community Care Licensing on the day she called to report the incident. LPA reminded director that unusual incidents need to be reported via telephone to the Department within 24 hours of occurrence. The written unusual incident report LIC624 is to be submitted with 7 days of the incident. Child fell face first and hitting her head. Director called mother and informed her of the incident immediately. Teacher applied ice to child's forehead after the incident. The center always calls parents if there is an injury to the head or the face or even biting incidents. After nap time, child vomited and father came to pick up child. Child continued to vomit in the car, so child was taken to the emergency room at the hospital. Child had a CAT scan and given an IV due to being dehydrated. Child was diagnosed with a mild concussion.

LPA interviewed the staff that were present during the incident. Director provided LPA copies of the accident report given to parents and the written communication between mother and staff. Center staff took the appropriate actions for the injury. No citations were issued and a notice of site visit was given to post. The report was reviewed with Director, Michelle Gordon and a copy was given.
Susana MartinezTELEPHONE: (805) 562-0400
Laura CaroneTELEPHONE: (805) 722-5138
DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2025
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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