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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207652
Report Date: 06/23/2023
Date Signed: 06/23/2023 03:37:17 PM

Document Has Been Signed on 06/23/2023 03:37 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GREAT PACIFIC CHILD DEVELOPMENT CENTERFACILITY NUMBER:
566207652
ADMINISTRATOR:JESSICA DERBYFACILITY TYPE:
840
ADDRESS:259 W.SANTA CLARA ST. 260&280TELEPHONE:
(805) 507-8335
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jessica Derby TIME COMPLETED:
03:40 PM
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On 06/23/22, at approximately 1:00 PM, Licensing Program Analyst (LPA) Giovani Gonzalez and Licensing Program Manager (LPM) Ana Tolentino conducted an unannounced Case Management inspection to evaluate the School Age Program to increase the capacity from 24 to 38 children. LPA and LPM met with Director Jessica Derby and informed the purpose of the inspection. At the time of inspection there were no children or staff due to an off site field-trip.

The facility is open Monday through Friday 7:30AM - 5:30PM, and closed every other Friday.

The director submitted an application to add a new classroom "Kids Club 2" to increase the capacity from 24 to 38 school age child (5-9 year olds) . The new classroom adds 2 toilets and 3 sinks to the School Age Program for a total of 4 toilets an 6 sinks. Total square footage indoor is 1,344 square feet which accommodates the new capacity of 38 school age children. The approximate outside square footage for the combined areas is 3,721 square feet which is plenty of space to accommodate 38 school age children.

A fire clearance was approved by the Ventura City Fire Department for 38 school age children on 6/8/23.

The center meets Title 22 Division 12 requirements. License will be effective today, 06/23/2023 for total capacity of 38 school age children.

Licensee representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center.

Continued LIC809-C
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: GREAT PACIFIC CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 566207652
VISIT DATE: 06/23/2023
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Director was made aware that it is the facility's responsibility to know the current regulations for a CCC which can be accessed on-line at www.cdss.ca.gov

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Jessica Derby.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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