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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561710730
Report Date: 07/18/2025
Date Signed: 07/18/2025 12:45:59 PM

Document Has Been Signed on 07/18/2025 12:45 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:ROOTS & WINGS FAMILY DEVELOPMENT CENTERFACILITY NUMBER:
561710730
ADMINISTRATOR/
DIRECTOR:		MICHELLE WILCOXFACILITY TYPE:
850
ADDRESS:1492 CALLE TULIPANTELEPHONE:
(805) 492-8560
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 16DATE:
07/18/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Beatriz MartinezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 07/18/25 at 10:00am , Licensing Program Analyst (LPAs) Brian Fung and Veronica Diaz made an unannounced inspection for the purpose of conducting a Case Management inspection. LPAs met with Beatriz Martinez to discuss an incident that was self-reported to Community Care Licensing Division (CCLD) office by phone on 07/03/25. LPAs toured the area/classroom where the incident occurred and interviewed Director and Staff.

On 7/2/25 an incident occurred at the center. At or around time 12:35pm. C1 was left inside the classroom after using the restroom, to whom. Staff (S2) observed the incident. S2 notified S1 that C1 was in the classroom playing with blocks alone. S1 immediately went inside to guide C1 back outside for lunch
Parents were contacted at pickup.The child returned to the facility the next day. To prevent any similar incidents, the Director has reinforced and updated their "Keeping children safe: policy and procedures for maintaining accountability for children" contract. Each staff was requested to review, sign, and place back into their personnel file.

Given the incident was observed by staff who took appropriate action by reporting to SBRO, because a similar prior incident happened of a child being left inside the classroom alone, a Typ B deficiency is being issued as a result of this incident.

Exit interview and review of report was conducted with Beatriz Martinez, appeals rights given, and notice of Site visit was provided and must be posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.
NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Brian Fung
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2025
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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Document Has Been Signed on 07/18/2025 12:45 PM - It Cannot Be Edited


Created By: Brian Fung On 07/18/2025 at 12:17 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: ROOTS & WINGS FAMILY DEVELOPMENT CENTER
FACILITY NUMBER: 561710730

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2025
Section Cited
CCR
101223(a)(6)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(6) Not to be locked in any room, building or center premises by day or night.
This requirement is not met as evidence by:
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LPAs recieved updated policy and procedures. Staff reviewed, signed and filed new procedures. All staff was reminded about counting ratios daily after every transition. Also verifying brightweel of ratios.
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Based on interview and record review, the licensee did not comply with the section cited above in S1 leaving C1 alone in classroom which poses a potential health, safety, or personal rights in care.
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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.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Brian Fung
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2025


LIC809 (FAS) - (06/04)
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