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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566217012
Report Date: 11/18/2025
Date Signed: 11/18/2025 01:38:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2025 and conducted by Evaluator Shane Loftus
COMPLAINT CONTROL NUMBER: 17-CC-20251114140623
FACILITY NAME:PERSEVERANCE CHRISTIAN ACADEMYFACILITY NUMBER:
566217012
ADMINISTRATOR:STEPHANIE CARVERFACILITY TYPE:
860
ADDRESS:101 N. SKYLINE DRIVETELEPHONE:
(818) 577-3334
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:96CENSUS: 17DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Mona GastaloniTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Children are enrolled without immunization records
INVESTIGATION FINDINGS:
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On 11/18/2025, at 12:01 PM, Licensing Program Analyst (LPA) Shane Loftus made an unannounced inspection to initiate the investigation of the above-mentioned allegation. LPA met with Mona Golastani, Licensee of the Child Care Center (CCC) and explained the nature of the inspection. LPA notes 17 children were present during the inspection.

The investigation included records review and one unannounced site inspection. As noted above, the specific allegation of the complaint is that children are enrolled without immunization records

LPA was able to corroborate the allegation of the complaint through records review. LPA found that C1, C2, and C3 do not have current immunization records or medical exemptions on file.

Continued on 809-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 17-CC-20251114140623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PERSEVERANCE CHRISTIAN ACADEMY
FACILITY NUMBER: 566217012
VISIT DATE: 11/18/2025
NARRATIVE
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Based on LPA's records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12 and CCR 101220.1(a) is being cited).

Licensee was provided and advised of their right to appeal (LIC 9058). A copy of this report was reviewed and provided to the Licensee. The Notice of Site Visit (LIC 9213) was also provided to the Director as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20251114140623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: PERSEVERANCE CHRISTIAN ACADEMY
FACILITY NUMBER: 566217012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2025
Section Cited
CCR
101220.1(a)
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101220.1 Immunizations (a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.
This requirement is not met as evidenced by:
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Licensee will submit current immunizations or a medical exemption or C1, C2, and C3 to CCLD (shane.loftus@dss.ca.gov) by 11/28/2025.
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Based on records review, the licensee did not comply with the section cited above in that C1, C2, and C3 do not have current immunizations or a medical exemption on file.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Shane Loftus
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4