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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210497
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:04:18 PM


Document Has Been Signed on 05/18/2022 03:04 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: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: 10DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Emiko MadisonTIME COMPLETED:
03:20 PM
NARRATIVE
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On May 18, 2022 at 12:35 PM, Licensing Program Analysts (LPA) Dean Thompson conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with Director Emiko Madison and advised the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 10 children in care at the time of the inspection.

LPA observed required licensing documents mounted on the wall inside the Pre-School classroom. While reviewing required posting documents, LPA did not observe LIC 610 Emergency Disaster Plan form posted. LIC 610 was not available for review during the the inspection. Last fire drill was conducted on 3/31/2022.

Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care. LPA observed enough restrooms available for children to use. LPA did not observe any hazards/toxin items accessible to children. During nap time children are provided mats if they choose to sleep.

The outdoor playground is shaded and has an ample amount of space for children to play. LPA observed the playground has age-appropriate toys and structures available for children to use. Children bring water bottles from home and water is also available throughout the facility.

A sampling of children and staff records were reviewed. LPA observed children's files to be incomplete. During child records review, LPA observed C10 did not have a complete file. C10 was missing LIC 700, LIC 701, LIC 995, LIC 613A and LIC 627. Director was given time to bring the file but was told office staff was still searching for the forms.

Continued on LIC-809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
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 4


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: 05/18/2022
NARRATIVE
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LPA observed staff files to be incomplete. LPA reviewed six staff files. All files reviewed by LPA did not have a current Pediatric First Aid certification including the Director. LPA also observed all staff files did not have a current mandated reporter certification. Director was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


Director 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.



Four Type B deficiencies were cited during todays visit.

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 Director Emiko Madison

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 05/18/2022 03:04 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(a)
Disaster and Mass Casualty Plan
(a) Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. While reviewing required posting documents, LPA did not observe LIC 610 Emergency Disaster Plan form posted. LIC 610 was not available for review during the the inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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Director agreed to fill out the LIC 610 Emergency Disaster Plan form by POC due date and post the form so that the disaster plan is available for review.

Director is to send a copy to LPA via email or mail.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above.
LPA reviewed six staff files. All six staff files did not have a current mandated reporter certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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Director agreed to send a copies of all staff who completed the mandated reporter training to LPA via email or mail by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 05/18/2022 03:04 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA reviewed six staff files. All files revewed by LPA did not have a current Pediatric First Aid certification. Director was asked to provide CPR certification for any staff but was unable to do so which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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Director agreed to have staff conduct training and provide proof to LPA via mail or email by POC due date. Director was reminded, CPR certification is a requirement to be a director.
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. During child records review, LPA observed C10 did not have a complete file. C10 was missing LIC 700, LIC 701, LIC 995, LIC 613A and LIC 627. Director was given time to bring the file but was told office staff was still searching for the forms. LPA was unable to review required documents so the file was incomplete which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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Director was reminded children files need to be complete prior to enrollment. Director agreed to submit proof of the completed file via mail or email by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4