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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210497
Report Date: 11/21/2019
Date Signed: 11/21/2019 01:40:17 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: 35DATE:
11/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Bob FlemingTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Francisco Pedroza and Betzayra Cervantes conducted an unannounced Case Management inspection. LPAs met with facility Business Manager Bob Fleming and advised the purpose of the inspection was to provide a copy of an Accusation legal case number # 7819266001 and to ensure that Individual #1 was not present at the facility.

On 09/05/2019, the Department notified the facility that Individual #1 does not have a criminal record clearance and individual #1 cannot work, reside, or be present at the facility unless a criminal record exemption is granted. Business Manager provided LPAs a signed Confirmation of Removal for Individual #1 (LIC 300A).

During today’s inspection, LPA did not observe individual #1. Per Business Manager Individual #1 has not worked at the facility since the Confirmation of Removal was received.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children.

Exit interview conducted with Business Manager Bob Fleming. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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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