561711699-11-6-2024-17-CC-AZES-DARTLZ-20241106135022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 561711699
Report Date: 11/06/2024
Date Signed: 11/06/2024 01:50:35 PM

Document Has Been Signed on 11/06/2024 01:50 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:	CROSS ROADS CHILDREN'S CENTER		FACILITY NUMBER:	561711699
ADMINISTRATOR/ DIRECTOR:	MICHELLE GORDON		FACILITY TYPE:	850
ADDRESS:	2372 ERRINGER ROAD		TELEPHONE:	(805) 526-2887
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 63	DATE:	11/06/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Michelle Gordon		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 November 6, 2024 at 09:30 AM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Fernando Hernandez conducted an unannounced annual / random inspection. LPAs met with Director (D1), Michelle Gordon and announced the purpose of the inspection. D1 provided LPA with a tour of the interior and exterior of the facility. At the time of the inspection, there were 63 children under the care and supervision of 12 staff members. LPA observed required licensing documents mounted on the walls before entering facility. Last fire drill was conducted on November 4, 2024. The classroom had age-appropriate toys and furniture readily accessible for children in care. LPA observed enough restrooms available for children to use. LPA observed a bottle of Lysol spray within the bathroom that children use. LPA told D1 to remove the spray immediately due to it being a hazardous / toxic item to children. First Aid kits were observed hanging on the wall in each classroom which was fully stocked within the facility. Facility provides food for the children in care, and LPAs noticed menus properly posted within the facility. LPA reviewed lead testing results from testing conducted on 05/24/2024 and 08/23/2024 which had a sample finding of 17.00 in 05/24/2024 and 20.00 in 08/23/2024 for testing site H. LPA advised center to immediately stop using site H. D1 stated that they now have a water jug in place of testing site H and has gotten the site retested on October 24 and is waiting for results. The outdoor playground has shaded areas for children in care and has an ample amount of space for children to play. LPA observed the playground has age-appropriate toys and structures available for children to use. A sampling of children and staff records were reviewed. LPA reviewed 6 children's files and observed children's files to be complete and current. Currently the facility does not have children that require Incidental Medical services (IMS). LPA observed staff files to be complete and current. Staff present has current CPR an expiration date of 03/02/2025. All Staff present have current mandated reporter training certification. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements for all staff. Con'd on 809-C

Lissete Gonzalez	TELEPHONE: (805) -56-0400
Aaliyah Zendejas	TELEPHONE: (805) 722-5133
	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CROSS ROADS CHILDREN'S CENTER	FACILITY NUMBER: 561711699
	VISIT DATE: 11/06/2024

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.

Two Deficiencies were cited today. See LIC809-D for details.

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 Michelle Gordon.

SUPERVISOR'S NAME: Lissete Gonzalez	TELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: Aaliyah Zendejas	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 11/06/2024 01:50 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CROSS ROADS CHILDREN'S CENTER	FACILITY NUMBER: 561711699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in which LPA observed a bottle of Lysol on the counter, which read "keep out of reach of children" which was readily accessible to children which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2024
	Plan of Correction
1 2 3 4	Director is to remove Lysol and any other toxic or hazardous items from reach of children.

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.

Lissete Gonzalez	TELEPHONE: (805) -56-0400
Aaliyah Zendejas	TELEPHONE: (805) 722-5133
	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 11/06/2024 01:50 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CROSS ROADS CHILDREN'S CENTER	FACILITY NUMBER: 561711699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater ... the Action Level. (1) A result with values of 5.5 ppb ... shall be deemed an Action Level Exceedance. 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 which lead testing for cite H was above 5.5 ppb which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/20/2024
	Plan of Correction
1 2 3 4	Director is to send retested site results to SBRO. Director is to also maintain inaccessbility of site H until test results are clear if site H will continue to be in use.

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.

Lissete Gonzalez	TELEPHONE: (805) -56-0400
Aaliyah Zendejas	TELEPHONE: (805) 722-5133
	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4