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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215191
Report Date: 12/04/2024
Date Signed: 12/04/2024 09:43:26 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/04/2024 09:43 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:CHILDREN'S HAVEN SCHOOL AGE PROGRAM, THEFACILITY NUMBER:
566215191
ADMINISTRATOR/
DIRECTOR:		DESTINY ALVAREZFACILITY TYPE:
840
ADDRESS:38 TELOMA DR.TELEPHONE:
(805) 644-7722
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Diana EsquivalTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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On 12/04/2024 ,Licensing Program Analysts (LPA) German Negrete conducted an unannounced Annual/required inspection of the above mentioned school age program. LPA met with Diana Esquival, Lead Administrator of the school age program.. LPA explained the purpose and nature of the inspection. The after school program normal hours of operation are Monday- Friday 2:30PM- to 5:00PM. LPA did not observe any room being utilized for the after school program.

During the inspection LPA toured the facility inside and outside. LPA did not observe any children associated or receiving services from the program. Lead administrator stated to LPA, The school age program has been inactive since 9/30/2022 and has not provided services to children since 9/30/2022. Furthermore the facility wishes to return the license to a inactive status

LPA provided Lead Administrator with form LIC9211(request for inactive child care license).

Exit Interview conducted and report was reviewed with Lead Administrator
.
Notice of Site Visit was provided
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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