<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700073
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:56:52 PM

Document Has Been Signed on 10/13/2022 03:56 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CLIFF DRIVE CARE CENTERFACILITY NUMBER:
421700073
ADMINISTRATOR:YZNAGA, JENNYFACILITY TYPE:
850
ADDRESS:1435 CLIFF DR.TELEPHONE:
(805) 965-4286
CITY:SANTA BARBARASTATE: CAZIP CODE:
93109
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 23DATE:
10/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Jenny YznagaTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 13th at 3:15PM, Licensing Program Analyst (LPA) Rosie Breault made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with facility Director Jenny Yznaga and discussed the purpose of the visit. LPA and director conducted a tour of the facility. At the time of the inspection there were twenty-three (23) children and three (3) staff.

On 9/9/2022, director self-reported an incident regarding a child breaking humerus bone from sliding down a slide.

LPA observed slide to be functioning with no defects. Soft padding cushioning is underneath the slide. Director states C1 was sliding down in a crouched position. Roughly three quarters of the way down, he fell to right on his arm. Teacher Veronica and Teacher Miguel were present, and Teacher Veronica witnessed the fall. She went to C1 who did not indicate any pain and teacher offered ice and comfort. C1 declined ice. Teacher Miguel sat with C1 who did not express pain, although right arm at side, C1 continued to play. Staff informed parents of fall, who took C1 to doctor. C1 has cast on right arm and return to school at next scheduled day. Parents did not state medication or ointment to be rendered to child. Child was not allowed on climber during case and one week post removal of case.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED 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 WILL APPLY.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1