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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207652
Report Date: 02/24/2025
Date Signed: 02/24/2025 02:45:32 PM

Document Has Been Signed on 02/24/2025 02:45 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:GREAT PACIFIC CHILD DEVELOPMENT CENTERFACILITY NUMBER:
566207652
ADMINISTRATOR/
DIRECTOR:		JESSICA DERBYFACILITY TYPE:
840
ADDRESS:259 W.SANTA CLARA ST. 260&280TELEPHONE:
(805) 507-8335
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
02/24/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:36 PM
MET WITH:Jessica DerbyTIME VISIT/
INSPECTION COMPLETED:
03:01 PM
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On 2/24/2025 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of completing a Case Management - Incident inspection .Today LPA met with Center Program Manager Jessica Derby and LPA informed Program Manager the purpose for todays inspection. Today, LPA did a walk through of the Child Care Center(facility) with Program Manager. LPA observed at the time of the walk-through zero children and two staff present.

On 02/11/2025 Program Manager contacted Community Care Licensing (CCL) to self-report the following unusual incident : A school aged teacher(S2) was walking with C1 to go to the on site cafe to pick something up. Then S2 observed a pre-approved dog tied to a pole. S2 approached dog to pet the dog. Then C1 also approached the dog to pet it. RP stated the dog jumped up and snipped up at C1's face(See LIC812).

During todays inspection LPA conducted children’s file review(see LIC857), staff file review(see LIC859). Additionally LPA confirmed LIC624 was submitted by Program Manager on 2/13/2025 via email.

Today LPA requested a copy the facility children's roster and staff roster. More information needs to be obtained/verified before closing the case management review of the 2/11/2025 incident.


Exit interview was conducted and report was read to Program Manager Jessica Derby.

Notice of site visit was provided.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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