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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566210498
Report Date: 05/17/2019
Date Signed: 05/17/2019 12:00:03 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:CDI - HAYCOXFACILITY NUMBER:
566210498
ADMINISTRATOR:RACHEL CHAMPAGNEFACILITY TYPE:
850
ADDRESS:5400 PERKINS RD.TELEPHONE:
(805) 488-3578
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:24CENSUS: 22DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Cecilia LopezTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Michael Avila made an unannounced visit for the purpose of conducting a Required Annual visit. LPA's Avila met with Cecilia Lopez and discussed the nature and purpose of the facility visit. A tour of the facility was conducted. All indoor and outdoor activity areas were inspected.

The Facility is a Title 5 preschool operating with 1 classroom. The facility operates three sessions from 7:00 a.m. to 10:00 a.m, 11:00 a.m. to 2:00 p.m. and 3:00 to 6:00 p.m. Furniture and equipment is in safe condition and are age appropriate for preschool children. Toilets and hand washing facilities are in clean and sanitary condition. Floors are clean and safe and free of hazards accessible to children. All trash cans have covers. Kitchen food preparation area is clean and sanitary and food is properly stored. Menus are posted in visible location for parent's view. There is drinking water and disposable cups available in the classrooms and in the outdoor play area.

Areas around and under the climbing play equipment have sufficient and appropriate cushioning material to absorb falls. There are no bodies of water on the center grounds. All materials and surfaces accessible to children are free of hazards and toxic free. Medications are properly labeled and stored in a locked box that is kept in a locked storage room. One child was identified receiving an Incidental Medical Service. Staff vaccinations were discussed with the Director. Sign in/out sheets reviewed are in compliance. All classrooms have age appropriate furniture, toys, teaching material and supplies for children. Children's and staff records reviewed are in compliance. All staff present have a criminal record clearance.

Current CPR and First Aid certification was verified for staff present. IMS plan was discussed with the Director and noted on a separate detail supportive of a child receiving such services. No deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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