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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210497
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:36:28 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: 30DATE:
03/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Emiko MadisonTIME COMPLETED:
01:50 PM
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On March 5, 2020 at 12:30, Licensing Program Analysts (LPA’s) Francisco Pedroza and Austin Rios conducted an unannounced Case Management inspection. LPA’s met with facility Business Manager Bob Fleming and Director Emiko Madison and advised the purpose of the inspection was to provide a copy of a Decision and Order legal case number # 7819266001 and to ensure that S1 was not present at the facility.

During today’s inspection LPAs toured the entire facility and did not observe S1 is present. Per Business Manager Bob Fleming, S1 has not worked at the facility since 08/30/2019. According to the Decision and Order, S1’s criminal record exemption is affirmed and S1 is prohibited from employment in, presence in, and contact with clients of, any facility licensed by the Department, certified or approved by a licensed foster family agency, or any resource family home, and from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, until S1 obtains a criminal record exemption. S1 may not re-apply for a criminal record exemption for a period of two (2) years from the effective date of this decision. The Decision and Order was signed December 11, 2019 and became effective December 23, 2019.

The Acknowledgement of Receipt of Licensing Reports (LIC9224) for the providing a copy of the Accusation shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: www.ccld.ca.gov. Continued on 809-C

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

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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: CARDEN CONEJO SCHOOL
FACILITY NUMBER: 566210497
VISIT DATE: 03/05/2020
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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 Director Madison. 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: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC809 (FAS) - (06/04)
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