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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710899
Report Date: 02/20/2026
Date Signed: 02/20/2026 06:47:52 PM

Document Has Been Signed on 02/20/2026 06:47 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:DEL MAR ELEMENTARY SCHOOL - KID'S CLUBFACILITY NUMBER:
401710899
ADMINISTRATOR/
DIRECTOR:		ANGELICA GALLARDOFACILITY TYPE:
840
ADDRESS:501 SEQUOIA, ROOM 25TELEPHONE:
(805) 772-6278
CITY:MORRO BAYSTATE: CAZIP CODE:
93442
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 37DATE:
02/20/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:01 PM
MET WITH:Angelica JepsenTIME VISIT/
INSPECTION COMPLETED:
07:05 PM
NARRATIVE
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On February 20, 2026 Licensing Program Analysts (LPAs) Elizabeth George and Bill Billones conducted an unannounced Case Management inspection at the above-mentioned Child Care Center (CCC). LPAs met with Angelica Jepsen, Administrator of the CCC, and discussed the purpose of the inspection. LPAs note 37 children in the care of 6 staff were present at the time of the inspection.

During the course of the complaint investigation, the administrator stated that two employees began working at the start of the year and were in the process of obtaining criminal record clearances. LPAs verified through Guardian that these staff members are not associated with the facility and do not have an approved criminal record clearance. This constitutes a violation of Title 22, Division 12, Chapter 1. One Type A deficiency and a civil penalty of $500 per person are being issued, as documented on the attached LIC 809-D.

LPAs observed children walking unsupervised from the classroom to the playground. The walkway to the playground was not within the direct line of sight of the classroom. This constitutes a violation of Title 22, Division 12, Chapter 1. One Type B citation has been issued and is documented on the attached LIC 809-D.

The center participates in a workforce program that involves students. LPAs requested a copy of the agreement between the center and the school. Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Elizabeth George
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2026
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: DEL MAR ELEMENTARY SCHOOL - KID'S CLUB
FACILITY NUMBER: 401710899
VISIT DATE: 02/20/2026
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The center was unable to provide any documentation of this agreement. This constitutes a violation of Title 22, Division 12, Chapter 1. One technical violation has been cited and is documented on the attached LIC 9102.

During today’s visit, one Type A deficiency and one Type B deficiency are being cited under CCR, Title 22, Division 12, as documented on the attached LIC 809-Ds. In addition, one technical violation is being issued.

LPA informed Program administrator that this report dated 2/20/26 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Upon receipt of this report, CCC is to provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeals rights were given and report was reviewed with program administrator, Angelica Jepsen.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Elizabeth George
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/20/2026 06:47 PM - It Cannot Be Edited


Created By: Elizabeth George On 02/20/2026 at 05:48 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: DEL MAR ELEMENTARY SCHOOL - KID'S CLUB
FACILITY NUMBER: 401710899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2026
Section Cited
CCR
101170(e)(1)

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(1) Obtain a California clearance or a criminal record exemption as required by the Department

This requirement is not met as evidenced by:
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Staff are to obtain a criminal record clearance. Staff are not to be present in the facility until the clearance has been granted.
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Based on LPAs record review two of six staff members have not received a criminal record clearance which poses an immediate health and safety risk to children.
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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:
Elizabeth George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/20/2026 06:47 PM - It Cannot Be Edited


Created By: Elizabeth George On 02/20/2026 at 05:54 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: DEL MAR ELEMENTARY SCHOOL - KID'S CLUB
FACILITY NUMBER: 401710899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
101170(a)(1)

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(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Facility is to submit a written plan to the department on how 100% supervision will be maintained. This plan shall be submitted via email to elizabeth.george@dss.ca.gov no later than February 27, 2026.
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Based on LPAs observation multiple children were walking unsupervised from the classroom to the playground. The walkway to the playground was not within the direct line of sight of the classroom which poses a potential health and safety risk to children.
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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:
Elizabeth George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2026


LIC809 (FAS) - (06/04)
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