197414519-3-17-2022-17-CC-DTHN-CCM25E-20220317170526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414519
Report Date: 03/17/2022
Date Signed: 03/17/2022 05:05:32 PM

Document Has Been Signed on 03/17/2022 05:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	NEW YERBA BUENA ELEMENTARY SITE, THE		FACILITY NUMBER:	197414519
ADMINISTRATOR:	JAMIE GONZALEZ		FACILITY TYPE:	840
ADDRESS:	6098 REYES ADOBE RD.		TELEPHONE:	(818) 735-0112
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	60	CENSUS: 24	DATE:	03/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Nicole Sheldon		TIME COMPLETED:	05:20 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	On March 17, 2022 at 3:15 PM, Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with director Nicole Sheldon and advised the purpose of the inspection. LPA conducted a tour inside and outside. There were 24 children in care at the time of the inspection. LPA observed required licensing documents mounted on the wall near the entrance. Last fire drill was conducted 2/2022. Each of the classrooms have age-appropriate toys, activities, and furniture readily accessible for children in care. Children use two bathrooms across from their classrooms, designated for after school use only. LPA did not observe any hazards/toxins items accessible to children. First Aid kit observed and locked. Currently the facility uses an App called Daxko for sign in and sign out. Facility provides afternoon snacks. Children play at the campus under supervision of the staff. There were no bodies of water present during today's visit. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility does not have children that require Incidental Medical services (IMS). LPA observed an expired mandated reporter certification belonging to the director which expired 8/30/2021. CPR current with an expiration date of 1/30/2024. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NEW YERBA BUENA ELEMENTARY SITE, THE	FACILITY NUMBER: 197414519
	VISIT DATE: 03/17/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director 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.

One Type B deficiency was cited during today's inspection.

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, appeal rights were given, and report was reviewed with director Nicole Sheldon.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/17/2022 05:05 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: NEW YERBA BUENA ELEMENTARY SITE, THE	FACILITY NUMBER: 197414519
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the facility did not comply with the section cited above. Director did not provide LPA proof of the mandated reporter certification. Director manadated reporter certification expired 8/30/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2022
	Plan of Correction
1 2 3 4	Director to send proof of mandated reporter certification (AB1207) to LPA Thompson via text or email by plan of correction due date. www.mandatedreporterca.com

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: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

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