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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210153
Report Date: 11/22/2021
Date Signed: 11/22/2021 01:10:34 PM

Document Has Been Signed on 11/22/2021 01:10 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:ISLA VISTA CHILDREN'S CENTERFACILITY NUMBER:
426210153
ADMINISTRATOR:ERIKA MALDONADOFACILITY TYPE:
830
ADDRESS:6842 PHELPS RD.TELEPHONE:
(805) 968-0488
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 14DATE:
11/22/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Elizabeth PadillaTIME COMPLETED:
01:15 PM
NARRATIVE
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A case management was conducted by (LPA) Licensing Program Analyst S. Mendoza-Ceja who met with Site Supervisor Elizabeth Padilla in order to document the following violation.

Review of staff records revealed staff #1 was utilized as a infant teacher and is also documented on the Personnel Report as a teacher in the Bunnies classroom. Although, staff #1 is a fully qualified preschool teacher staff #1 lacks the required 3 units in infant care.

Based on LPA's, interviews, and record review, the following B deficiency is cited on page #2 according to California Code of Regulations, Title 22, Division 12 & Chapter 101416.2(c)(1)(A).

An exit interview was conducted, and Plan of Correction was reviewed and developed with the Site Supervisor and Program Manger (telephone). A copy of this report and appeal rights were discussed and left with the Site Supervisor.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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Document Has Been Signed on 11/22/2021 01:10 PM - It Cannot Be Edited


Created By: Sylvia Mendoza-Ceja On 11/22/2021 at 08:59 AM
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: ISLA VISTA CHILDREN'S CENTER
FACILITY NUMBER: 426210153

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2021
Section Cited
CCR
101416.2(c)(1)(A

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Infant Care Teacher Qualifications and Duties: To be a fully qualified infant care teacher, a teacher shall have the following: Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants.
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Correct Immediately.
Please submit a plan of correction to Licensing for review by 11/24/2021.
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This requirement is not met as evidenced by LPAs interviews and record review which revealed Staff #1 was utilized as an infant teacher and does not have infant units.

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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:Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2021


LIC809 (FAS) - (06/04)
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