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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210209
Report Date: 01/03/2020
Date Signed: 01/03/2020 12:18:58 PM

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:CDR - BERYLWOOD HEAD START CENTERFACILITY NUMBER:
566210209
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2300 HEYWOOD ST.TELEPHONE:
(805) 583-3775
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:43CENSUS: 28DATE:
01/03/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Jennie WillTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Betzayra Cervantes and Francisco Pedroza made an unannounced visit to conduct an Annual/Random inspection. LPA's met with Site Supervisor Jennie Will and discussed the nature and purpose of the visit and together a tour of the facility was conducted both inside and outside. There was total of 28 children under the care and supervision of 5 teachers. There is a total of two classrooms, "G" and "F", located on the school grounds of Berylwood Elementary School. The center currently operates from August to June, 8:00 AM to 2:00 PM Monday through Friday.

The classrooms were observed free of hazards and all classrooms are equipped with age appropriate toys, teaching materials, and furnishings for children in care. The bathrooms were observed clean and sanitary. Waste containers have tight-fitting covers. The playground is fenced with appropriate shading and was observed in good condition and free of hazards. The areas around or under high climbing equipment have cushioned material. No bodies of water were observed on the premises. There is drinking water readily available for children inside and outside the classrooms. The facility provides breakfast, lunch and snack for children in care. Menus were posted prominently on the wall along with the site's facility license and Emergency Disaster Plan.

Sign in/out sheets were reviewed and found complete. All staff have a criminal record clearance. Staff records are located at the CDR Human Resource Office and will be reviewed at a later date. A sampling of children records was reviewed and found current and complete. CPR and First Aid cards are current with an expiration date of 01/17/2021.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
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 2
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: CDR - BERYLWOOD HEAD START CENTER
FACILITY NUMBER: 566210209
VISIT DATE: 01/03/2020
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This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2