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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 02:27:49 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:
12:35 PM
MET WITH:Cyndi AyalaTIME VISIT/
INSPECTION COMPLETED:
02:45 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 4/23/2024. Specifically, the incident involved children in care, C1 stated C2 touched them inappropriately . 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 4/18/2024 was 16 children and 3 staff. Site Manager stated C1 told parent that C2 touched them inappropriately on the play yard no staff witnessed the incident, Staff contacted parent. Site Supervisor stated they talked to C1 parent and assured them CCC is doing everything they can to provided health and safety to all the children in care. Site Manager reported CCC has conducted investigation and made proper updates to ensure this incident does not occur again.

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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LPA investigated this incident and based interview with Site Supervisor, parent interview, record reviews and LPA personal observation CCC acted quickly and appropriately to the incident. CCC 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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