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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710981
Report Date: 11/28/2022
Date Signed: 11/28/2022 02:15:33 PM

Document Has Been Signed on 11/28/2022 02:15 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:SANTA YNEZ BRANCH - SANTA YNEZ ELEMENTARYFACILITY NUMBER:
421710981
ADMINISTRATOR:KRISTINE PARRAFACILITY TYPE:
840
ADDRESS:3325 PINE STREET, BLDG #27TELEPHONE:
(805) 686-2037
CITY:SANTA YNEZSTATE: CAZIP CODE:
93460
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
11/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Kristine ParraTIME COMPLETED:
02:30 PM
NARRATIVE
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On 11/28/2022 at 1:17 PM, Licensing Program Analyst (LPA) Austin Rios conducted an unannounced Case Management inspection. LPA met with facility Director Kristine Parra and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were two staff and 17 children in care at the time of the inspection.

On 10/18/2022, Director self reported On 10/17/22, while staff members were monitoring children using the restroom, C1 and C2 walked around the other side of the building and one child did reach over to touch and the teacher was coming around the corner and children pulled up pants. A witness to the incident (a school parent) stated C2 initiated the touching. Child 1 confirmed Child 2 initiated the touching. The area where the children touched each other was unknown to staff. C1 and C2 were separated immediately by staff and the parents of children were called, Elementary School Principal informed of incident.

Today, LPA inspected the area and observed where the incident took place. The Director reported the incident and submitted the incident report to the Department as required. LPA advised the director that the incident was an absence of supervision.

The following CCR, Title 22, Division 12 Type A regulation was cited 101229(a)(1) Responsibility for Providing Care and Supervision

LPA informed director that this report dated 11/28/2022 and one Type A citation shall be posted for 30 consecutive days as there were immediate risk(s) to the health, safety, or personal rights of children in care.

Cont. on 809-C.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SANTA YNEZ BRANCH - SANTA YNEZ ELEMENTARY
FACILITY NUMBER: 421710981
VISIT DATE: 11/28/2022
NARRATIVE
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Also, LPA Austin Rios informed the director to provide a copy of this licensing report dated 11/28/2022 that documents any Type A citation must be given to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the facility director.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022
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Document Has Been Signed on 11/28/2022 02:15 PM - It Cannot Be Edited


Created By: Austin Rios On 11/28/2022 at 02:00 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: SANTA YNEZ BRANCH - SANTA YNEZ ELEMENTARY
FACILITY NUMBER: 421710981

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1): Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ...to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher ... visual observation.
This requirement is not met as evidenced by:
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Director will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations and avoid any children left unattended by 12/5/2022.
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Based on LPA's observation during the inspection tour and director self-reporting the incident, Child #1 and Child #2 were left unsupervised. This is an immediate risk to the health and safety of the children in the facility.
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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.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Austin Rios
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022


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