566210209-8-15-2023-17-CC-SMAZ-CUQSC3-20230815134454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566210209
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:45:00 PM

Document Has Been Signed on 08/15/2023 01:45 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:	CDR - BERYLWOOD HEAD START CENTER		FACILITY NUMBER:	566210209
ADMINISTRATOR:	SUZANNE GODINEZ		FACILITY TYPE:	850
ADDRESS:	2300 HEYWOOD ST.		TELEPHONE:	(805) 583-3775
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	43	CENSUS: 0	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Norma Mata- Family Services Specialist		TIME COMPLETED:	02:00 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 August 15, 2023, Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Required- 1 year and change of rooms inspection. LPA met with Norma Mata- Family Services Specialist, and advised her the purpose for the inspection. Norma provided LPA a tour of the facility inside and out. There were no children present at the time of inspection. 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 program is set to start on 08/21/2023. LPA observed required licensing documents mounted on the walls throughout the facility. LPA reminded Norma that fire and disaster drills shall be conducted and documented every 6 months. Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care. Toilets and sinks were found to be in sanitary operating condition. LPA did not observe any hazards/toxins items accessible to children. First Aid kits were observed throughout the facility. The facility provides breakfast, lunch and snacks which are prepared and delivered by the school district. The outdoor playground is fenced and has appropriate shading. The age-appropriate play structure and play equipment were observed to be in good condition and free of hazards. The areas around and under high climbing equipment have cushioned material. The Department received an application for a room change due to construction in Room G. A fire clearance was granted by the Ventura County Fire Department on 5/31/2023. Room G was observed to be free of any hazardous/toxic items. Construction was observed to be complete and room is ready for conducting child care services. Site keeps personnel files off-site. LPA spoke with Suzanne Godinez, director of early care and education programs, and requested staff files. LPA is to review staff files at a later time. No children files were reviewed at this time as no children were present and the program is set to start on 08/21/2023. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: CDR - BERYLWOOD HEAD START CENTER	FACILITY NUMBER: 566210209
	VISIT DATE: 08/15/2023

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

Family Services Specialist 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.

No deficiencies were 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 and report was reviewed with Family Services Specialist Norma Mata.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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