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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210209
Report Date: 07/24/2024
Date Signed: 07/24/2024 02:27:23 PM

Document Has Been Signed on 07/24/2024 02:27 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:CDR - BERYLWOOD HEAD START CENTERFACILITY NUMBER:
566210209
ADMINISTRATOR/
DIRECTOR:		SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2300 HEYWOOD ST.TELEPHONE:
(805) 583-3775
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 0DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Cyndi AyalaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 7/24/2024 Licensing Program Analyst (LPAs) Veronica Diaz and David Roman conducted a Case management incident inspection at the Child Care Center (CCC), for the purpose of following up on the report of an Unusual Incident Report (UIR) received by the Department on 4/26/2024. Specifically, the incident involved children in care, C1 and C2 they were demonstrating inappropriate behavior . LPAs met with Family Service Specialist (FSS) Norma Mata due to the site being closed for the summer. LPAs were able to do a tour and discuss the purpose of today's inspection. FSS provided us with the Site Managers Cindy Ayala phone number LPAs interviewed Site Manager over the phone. LPAs notes 0 children and 1 staff were present during inspection.

Site Manager Stated ratio for 4/25/2024 was 16 children and 4 staff. Site Manager stated that themselves and 2 other staff were on the yard. They had just walked out and C1 and C2 ran away from the group C1 and C2 went on top the play structure, Site Manager stated that is when they walked over to the structure and that’s when they witnessed the inappropriate incident happening between C1 and C2. Site Manger stated C1 continues to be enrolled in the facility and parents have not expressed terminating services. C2 was still enrolled until this school year due to C2 going into Kindergarten. Site Manger stated No other children witnessed the incident. Site Supervisor stated they had a meeting with C1 parent but C2 parent was not available for an in person meeting due to work schedule so they talked to them over the phone. Site Manager stated they had a presentation from interface and have been extra diligent, CCC also has put a mirror to avoid a further incident and avoid having a blind spot. CCC ensures all areas will be always supervised even visual areas.

CONT 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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: CDR - BERYLWOOD HEAD START CENTER
FACILITY NUMBER: 566210209
VISIT DATE: 07/24/2024
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Site Manager reported CCC has conducted investigation, cross reported incident to CPS, and made proper updates to ensure this incident does not occur again.

LPA investigated this incident and based interview with Site Supervisor, record reviews and LPA personal observation CCC acted quickly and appropriately to the incident. CCC made improvements to the play structure to avoid the blind spot also provided training to children (interface presentation) My Body Belongs To Me to support children's awareness and education.

During today’s inspection no deficiencies issued.

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

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

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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