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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210497
Report Date: 09/05/2019
Date Signed: 09/05/2019 12:55:28 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:CARDEN CONEJO SCHOOLFACILITY NUMBER:
566210497
ADMINISTRATOR:EMIKO MADISONFACILITY TYPE:
850
ADDRESS:975 EVENSTAR AVE.TELEPHONE:
(805) 497-7005
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91361
CAPACITY:85CENSUS: 43DATE:
09/05/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Bob Fleming TIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Francisco Pedroza and Betzayra Cervantes conducted an unannounced inspection to conduct a Confirmation of Removal (COR). LPAs met with facility owner and Business Manager, Bob Fleming and explained the purpose of the inspection. LPAs and Mr. Fleming together toured the facility inside and out. The facility had 43 children in care at the time of the inspection.

LPAs discussed a Confirmation of Removal for S1.

Licensee filled out the exemption denial and forwarded it to LPA Pedroza via email. He stated that they plan to appeal the exemption denial for S1. Licensee stated the individual no longer works in the facility until further notice.

Based on evidence obtained during today's visit, the LPAs have verified the individual is not present, employed or residing at the facility. LPA has advised the Licensee to disassociate the individual from their roster.

No deficiencies cited.

Verification of removal is complete.

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) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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