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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561711888
Report Date: 06/26/2024
Date Signed: 06/26/2024 01:37:59 PM

Document Has Been Signed on 06/26/2024 01:37 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:ST. SEBASTIAN SCHOOL/PRESCHOOLFACILITY NUMBER:
561711888
ADMINISTRATOR/
DIRECTOR:		ANNETTE ROMEROFACILITY TYPE:
850
ADDRESS:325 E. SANTA BARBARA ST.TELEPHONE:
(805) 933-5518
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: DATE:
06/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 AM
MET WITH:Debra MorenoTIME VISIT/
INSPECTION COMPLETED:
01:45 AM
NARRATIVE
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On 06/26/2024 Licensing Program Analyst (LPAs) Veronica Diaz and David Roman conducted a Case management incident inspection at the Child Care Center (CCC), During a complaint inspection 2 incidents accrued that were not reported to Licensing. Specifically, the incident involved a 2 children in care, C1 fainted 911 was called C1 was transported to the hospital by parent, C2 had asthma attack was unresponsive 911 was called was transported to hospital by ambulance. LPAs met with Supervening Teacher Debra Moreno to discuss the purpose of today's inspection. LPA notes 11 children and 2 staff were present during inspection.

Supervising Teacher informed Licensing, they are aware of both incidents accruing at the center they were not here at the time of the incidents . Supervising Teacher stated that staff contacted them in 1 of the incidents on direction on what to do, Supervising Teacher informed staff to call 911. The second incident Supervising Teacher was told by Director when Supervising Teacher came in later that morning.

LPAs and Supervising Teacher discussed reporting requirements. LPAs gave Supervising Teacher reporting requirements regulation out of Tittle 22 .

LPA investigated this incident and based interview with staff and record reviews there is sufficient evidence in lack reporting incidents to support that resulted in C1 and C2 needing medical treatment on two different occasions. Therefore, the following deficiencies will be sited today 101212 (a)(d)(b) and a Technical Advisory 101626 (a)(c)(1)(2)(a)(b)(c)(d)(e)(f) an explanation was given to Supervising Teacher and a copy of Tittle 22 regulation on Heath Services for IMS plan.

CONT 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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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: ST. SEBASTIAN SCHOOL/PRESCHOOL
FACILITY NUMBER: 561711888
VISIT DATE: 06/26/2024
NARRATIVE
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Following the incident C1 and C2 continues to be enrolled in the CCC.

During today’s inspection 1 type B and 1 technical assistance was provided.

Exit interview and review of report was conducted with Supervising Teacher Notice of Site visit was provided and must remain posted for the next 30 days.

Appeal Rights given.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2024 01:37 PM - It Cannot Be Edited


Created By: Veronica Diaz On 06/26/2024 at 11:46 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: ST. SEBASTIAN SCHOOL/PRESCHOOL
FACILITY NUMBER: 561711888

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2024
Section Cited
CCR
101212(a)(d)(b)

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101212 Reporting Requirements
(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following...
This requirements is not met as evidence by:
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Director will write a written directive on how reporting requirements will be meet also Director will write a plan on how they will report any incidents to licensing and parents and have a training for staff.
An office meeting will be set at a later date with Principle/Director and Licensee
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Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety, or personal rights risk to persons 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.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Veronica Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


LIC809 (FAS) - (06/04)
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