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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216610
Report Date: 11/04/2024
Date Signed: 11/04/2024 04:39:27 PM

Document Has Been Signed on 11/04/2024 04:39 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:PACIFIC CAMPS FAMILY RESOURCE,INC.FACILITY NUMBER:
566216610
ADMINISTRATOR/
DIRECTOR:		KENNETH HARLEYFACILITY TYPE:
860
ADDRESS:4050 MARKET STREETTELEPHONE:
(805) 654-0686
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 4DATE:
11/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:26 PM
MET WITH:Hunt DolemanTIME VISIT/
INSPECTION COMPLETED:
03:27 PM
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On 11/4/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced visit to conduct a Case Management – Other inspection. LPA requested the assistance of licensing coordinator and center staff in order to verify the accuracy of licensing document confidential names list (LIC811). LPA met with Curry Hunt Doleman and the purpose of the visit was discussed. LPA observed 4 children being supervised by 1 staff.

During the inspection, LPA conducted a walk through of the Child Care Center with program director . Additional LPA conducted a children file review. LPA completed the file review and verified the accuracy of a LIC811 confidential names list.

LPA conducted exit interview with Hunt Doleman.

A technical violation was issued today.

Notice of site visit was provided.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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