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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216153
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:51:50 PM

Document Has Been Signed on 03/07/2024 01:51 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:LARRIVEE FCC AKA SUNNYSIDE ADVENTURES PRESCHOOLFACILITY NUMBER:
566216153
ADMINISTRATOR:KIMBERLY LARRIVEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 701-2820
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Kimberly LarriveeTIME COMPLETED:
02:00 PM
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On 3/7/2024 at 12:33PM, Licensing Program Analysts (LPAs) German Negrete and Sylvia Ceja conducted an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPAs met with Licensee Kimberly Lerrivee discussed the purpose of the visit. LPAs toured the Family Child Care Home(FCCH) with the Licensee. LPAs observed 4 children and 2 staff providing care and supervision at FCCH.

On 03/01/2024, Licensee contacted Community Care Licensing (CCL) to self-report an unusual incident which occurred on 02/29/2024 involving C1 who sustained an injury to his wrist which required medical attention.

LPAs obtained the child care roster, conducted review of child #1's file and licensee and assistant's file. Licensee also provided additional documentation for review.

LPAs advised further review of incident is required.

No deficiencies were observed during the visit.

Exit interview was conducted, report reviewed, and copy was provided to Licensee. Notice of site visit was provided. Appeal rights were given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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