197407367-8-20-2019-30-CC-SGUZ-BF8SPW-20190820140348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197407367
Report Date: 08/15/2019
Date Signed: 08/20/2019 02:04:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	AFTER SCHOOL CAMP CALABASAS AT LUPIN HILL		FACILITY NUMBER:	197407367
ADMINISTRATOR:	RUBIN, JEFF		FACILITY TYPE:	840
ADDRESS:	26210 ADAMOR ROAD		TELEPHONE:	(818) 880-6461
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	120	CENSUS:	DATE:	08/15/2019
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Briget Nelson		TIME COMPLETED:	05:28 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA’s) Antonio Almanza, Marastella Gutierrez and Licensing Program Manager (LPM) Victor Bautista conducted a scheduled visit to After School Camp Calabasas at Lupin Hill School located on Las Virgenes Unified School District Property on August 15, 2019. The Licensee operating this School-Age program is The City of Calabasas. The Purpose of todays visit is to inspect the facility for an increase of capacity from 120 to 160 School Age Children ages 4.9 to 11.9. We were greeted by Executive Director, Bridget Nelson and Executive Director, Carly Armacost who guided us on a tour of the facility inside and out at approximately 1:43 PM. According to prior Documentation of an unannounced Annual 3 Year visit conducted on 10/27/2016, Facility has 4 classrooms and 4 bathrooms in the bungalows. The Facility is also licensed to utilize the Heese Hall, to be used for older children. Indoor activity space previously used is being substituted by 6 new rooms, no change for the outdoor activity space. LPA Angelica Ramirez received a request from Executive Director, Bridget Nelson hand delivered to office LIC 200A (Application) requesting for an increase of capacity. Additional documents were received via email included LIC 999 (Facility Sketch) indicates that there is a total of 6 classrooms: Room 1 with 1 toilet and 2 sinks, Room 2 with 1 toilet and 2 sinks, Room 3 with 1 toilet and 2 sinks, Room 4 (Mini Multi-Purpose Recreation Room), Room 5 Art room, Room 6 Music Room with Stage and Steps. The following was observed during today’s visit: Upon arrival there were several construction areas throughout our tour of the facility by rooms 1-3, Entered Room 3, Observed a bulletin board with required posted notices including, Center License. LIC 610 (Emergency Disaster Plan, PUB 393 Parents Rights Notification, Menu of snacks for children. Areas appeared clean and organized. Furniture in good condition and refrigerator located in Room 3 is for

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella Gutierrez	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: AFTER SCHOOL CAMP CALABASAS AT LUPIN HILL	FACILITY NUMBER: 197407367
	VISIT DATE: 08/15/2019

NARRATIVE

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Room 6- 3^rd, 4^th and 5^th Grades. Mini Multi-Purpose Recreation Room #3B. Bathrooms located to the left when backdoor exit to secondary play yard and lunch area.
Boys- 2 toilets / 2 sinks/ 4 urinals
Girls- 3 toilets/ 3 sinks

Based on todays evaluation the following was discussed;

Directors stated that it will be complete by 1^st day off start of program Tuesday, August 20, 2019 and they will forward photos to LPA, Angelica Ramirez by 11:30am 8/20/19.

Last Visit inspection of this Facility was in 2016. Given that some items need to be updated LPA, Marastella Gutierrez requested additional documents. Executive Director, Nelson stated that she forwarded the following documents to LPA, Angelica Ramirez via email: Floor plans and sketch of the facility, Group planned activities, Admission Agreement, Mandated reporting Certification for 6 staff including both Executive Directors, LIC 500 Updated personnel roster, LIC 308 Authorization Designation of Facility Responsibility, Emergency Handbook and Incidental Medical Service Plan.

Items received today are:
Rules for Playground Equipment, Emergency preparedness Guide and handbook, LIC 500 (Personnel Roster), LIC 999 (Facility Sketch and Floor Plan), Memo for authorization from Director of Community Services of Calabasas with the 2 year lease agreement,

Executive Director, Bridgett Nelson states that in addition to the pictures requested that she will also forward via email to LPA, Angelica Ramirez the following documents: LIC 859 (Review of Staff) and LIC 309 Admissions Administrative Organization.

Due to Technical Issues the LIC 809 will be sent to Executive Director, Bridget Nelson via email and mail.

An exit interview was conducted, and a review of this report was discussed with Executive Director Nelson. Copy of (word version) report was provided.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella Gutierrez	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: AFTER SCHOOL CAMP CALABASAS AT LUPIN HILL	FACILITY NUMBER: 197407367
	VISIT DATE: 08/15/2019

NARRATIVE

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children’s snacks that need to be kept cool. Primary play yard located to the left of the school and secondary Play yard located directly behind rooms 1-3. There were no changes to outside areas. CCL staff also observed outside are stairway between rooms 1-2 visual bolts and open area below staircase. All rooms at facility had First-Aid Kits/ Emergency First-Aid backpacks, Smoke alarm/Carbon Monoxide detectors and Fire Extinguishers.

Room 1- Class room for Kindergarten and 1^st Grades. Observed several cabinets and cubbies. 1 sink. Also, in room located to the left backhand corner is the office where all children and staff files will be kept. Office area will be the isolation area where sick children will be kept.

Room 2- 2^nd and 3^rd grades that will transition from Room 3 when done with Homework. Observed cubbies and one storage cabinet for supplies. Also, in room is one bathroom with one toilet and one sink. One additional sink in classroom.

Room 3- 3^RD and 4^th grades homework room. One refrigerator, one bathroom with one sink and one toilet. One additional sink in classroom.

Room 4- 3^rd, 4^th and 5^th grades. Music room located left to the Administration Office. Back closet and copy room will not be accessible to the children.

Room 5- 4^th, 5^th and sometimes 3rd Grades (If necessary) Grades. Art room located in Room 1B by the primary play yard.
Bathroom use for these students will be the bungalows to the right of exit. Observed 4 water fountains.
Bungalows – Boys -2 toilets/2 urinals/2 sinks
Girls- 3 toilets/ 2 sinks

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella Gutierrez	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

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