197407367-6-7-2022-30-CC-DLOE-CF737K-20220607180003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197407367
Report Date: 06/07/2022
Date Signed: 06/07/2022 06:00:12 PM

Document Has Been Signed on 06/07/2022 06:00 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
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:	160	CENSUS: 93	DATE:	06/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Executive Director, Bridget Nelson		TIME COMPLETED:	06:00 PM

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On 6/07/2022 at 1:15 pm Licensing Program Analyst (LPA) Deborah Lowe, conducted an unannounced Annual Required Inspection for the school age license. LPA was greeted by Assistant Director, Raquel Munro and toured the facility indoors and outdoors. Days and hours of operation are Monday, Tuesday, Thursday, Friday 1:00 pm – 6:00 pm and Wednesday 11:00 am – 6:00 pm.

At 2:00 pm Executive Director, Bridget Nelson arrived, and LPA Lowe continued visit with Bridget.

Facility is located on the campus of Lupin Hill Elementary school. Facility utilizes after school bungalow rooms 1, 2, and 3. Facility is also authorized to use the music room, art room, and mini multipurpose room within the main building of the elementary school as needed. During visit only rooms 1, 2, and 3 were in use.

Due to all grade levels get out at different times, LPA conducted head counts a different time throughout the afternoon. At 1:31 pm LPA Lowe observed 34 children in grades TK-K on front outdoor area. At 2:15 pm LPA Lowe observed 51 children in grade levels 2^nd – 5^th at the lunch benches on the back outdoor area. At 3:41 pm LPA observed 8 children in 1^s grade in room 1. LPA Lowe observed a total of 93 children in care.

LPA reviewed facility Guardian Roster to verify staff with a cleared background clearance. LPA reviewed one staff member present but not in care of children during visit to show a status of “In Process”. LPA verified with Executive Director who looked at the Facility Guardian Roster on their device and verified the employee showed “In Process”. Executive Director sent employee home before they began working with children. Through interview of Executive Director and Assistant Director verified the employee was present in the facility for 2 days in the prior week. Facility will receive a Type “A” citation.

LPA advised per CCR 101216(i)(1) Personnel Requirements: (i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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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Document Has Been Signed on 06/07/2022 06:00 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101216(i)(1)

101216(i)(1) Personnel Requirements: (i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 employee was found to be without a criminal record clearance and present in facility for two days 6/1/2022 and 6/3/2022, employee status showed "In Process" in Guardian which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2022
	Plan of Correction
1 2 3 4	Executive Director corrected during visit by sending employee home at the start of the their shift and advised may not return until criminal record clearance is obtained. Executive Director verifed with LPA Lowe they know how to access and review Guardian System by accessing the facilities Guardian account online.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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: 06/07/2022

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No swimming pool or other bodies of water were observed on the premises. Disinfectants, cleaning solutions, and other hazardous items are made inaccessible. No poisons were observed during the inspection. Per the Executive Director medications are handled through the elementary school. After school program only allows for topical like sunscreen.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors in the facility are clean and safe.

Food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination. Contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers. Drinking water is available both indoors and outdoors.

Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls.

Facility has one functioning carbon monoxide detectors, LPA heard a successful test.

Capacity and limitations as specified on the license are being maintained. LPA verified at least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. LPA reviewed sign in/out sheets showing full signature used at pick up.

Facility maintains a ratio of one teacher supervising no more than 14 children in care. The licensee ensures children with obvious symptoms related to fever or vomiting are not accepted. Per the Executive Director children who are absent from the elementary school may not attend the after-school program. The facility is equipped to isolate and care for any child who becomes ill during the day in the Directors office.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and emergency medical authorization. Per Executive Director students enrolled in the elementary attend the after-school program, immunization records are on file in the elementary school office. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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: 06/07/2022

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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of their appeal rights.

LPA Lowe informed facility representative Bridget Nelson that this report dated 6/07/2022 documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Lowe informed the facility representative to provide a copy of this licensing report dated 6/07/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Bridget Nelson, Executive Director.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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