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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566209597
Report Date: 11/12/2025
Date Signed: 11/12/2025 01:43:42 PM

Document Has Been Signed on 11/12/2025 01:43 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:CDR - JULIE IRVING HEAD START CENTERFACILITY NUMBER:
566209597
ADMINISTRATOR/
DIRECTOR:		SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:231 VENTURA BLVD.TELEPHONE:
(805) 485-7878
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 41DATE:
11/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:58 AM
MET WITH:Maria MorenoTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On 11/12/2025, Licensing Program Analyst (LPA) Fernando Hernandez made an unannounced visit for the purpose of conducting a Case Management inspection. LPA Hernandez met with Site Supervisor Maria Moreno and discussed the nature and purpose of the visit.

Site supervisor self reported an incident that occurred on 10/23/2025, however the incident was reported to the department on 10/28/2025, where a child (C1) was discovered to have been left on the playground without supervision. The incident occurred at/or around 1:30PM - 2:00PM when children were transitioning from outside to inside the facility for their afternoon snack. (C1) was found on the playground slide left unsupervised when S2 noticed an empty seat which had food, prompting S2 to make a head count. Staff (S1, S2, & S3), who were preoccupied assisting children into the classroom, did not realize the child had walked back to the playground during transition. Staff stated (S2) escorted (C1) back into the classroom. S1, S2, and S3 roughly estimate C1 was left unsupervised for about 2-3 minutes. Staff stated parent was immediately notified of the incident. LPA questioned the site supervisor why the incident was reported to the department day(s) later. Site supervisor stated there was a miscommunication on who to make the report to.

LPA interviewed 3 teachers and Site supervisor involved in the incident. Based on the information gathered during the inspection, LPA determined that staff at the time of the incident made the appropriate action on informing the site supervisor as well as parent(s). The child did not leave the facility grounds, but staff had lost track of the child leading to child being left behind on the playground. Site Director states the facility has a plan of action to prevent similar incidents from occurring in the future.

During today's inspection, one Type B deficiency under Title 22 Division 12 was cited as a result of the incident, which can be found on the attached 809-D. Additionally a Technical Violation will be assessed under reporting requirements (please see LIC9102 for further details).

Notice of site visit was provided, appeal rights were given, and report was reviewed with Site supervisor Maria Moreno.

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2025
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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Document Has Been Signed on 11/12/2025 01:43 PM - It Cannot Be Edited


Created By: Fernando Hernandez On 11/12/2025 at 12:54 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: CDR - JULIE IRVING HEAD START CENTER
FACILITY NUMBER: 566209597

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2025
Section Cited
CCR
101229(a)(1)

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a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as .... (1). Supervision shall include visual observation.
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Site Supervisor stated the parent of the incident were informed and held a staff meeting to develop a plan to prevent any similar incident from reoccurring at the facility. Staff were given individual trainings for "Active Supervision", Staff were additionally written up by the facility.
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Facility staff left child unattended and unsupervised outside on playground for approximately 2-3 minutes.
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Staff and Site supervisor dicsussed new strategies to ensure children are visually supervised at all times.

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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.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Fernando Hernandez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2025


LIC809 (FAS) - (06/04)
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