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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212783
Report Date: 09/25/2019
Date Signed: 09/25/2019 01:01:31 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 - DEL NORTE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
566212783
ADMINISTRATOR:RACHEL CHAMPAGNEFACILITY TYPE:
850
ADDRESS:2500 LOBELIA DR.TELEPHONE:
(805) 988-3983
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:72CENSUS: 44DATE:
09/25/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Jennifer EscamillaTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Francisco Pedroza and Betzayra Cervantes conducted a Case Management - Deficiency inspection and met with Site Supervisor Jennifer Escamilla. LPAs and Site Supervisor together toured the facility inside and out. The facility had 44 children in care at the time of the inspection.

At approximately 10:23 am, LPAs met with facility Site Supervisor Escamilla. It was determined the facility did not notify Community Care Licensing (CCL) about an incident that occurred on 09/20/2019 between 10:20 and 10:30 am. A child was outside of the classroom unsupervised when their parent arrived to pick them up. LPAs advised Site Supervisor that any serious incident occurring at the facility, they are required to notify CCL within one business day. Site Supervisor advised that she understood.

The following CCR, Title 22, Division 12 regulation was cited: 101212(d)(1)(C) Reporting Requirements.

One Type B deficiency was cited today.

THE NOTICE OF SITE VISIT WAS POSTED
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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 2
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: CDI - DEL NORTE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 566212783
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2019
Section Cited

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101229 Reporting Requirements
(1) Upon the occurrence, during the operation of the child care center of any of the events ... following the occurrence of such event.
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidence by:
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Facility failed to notify Community Care Licensing about an incident that occurred on 09/20/2019 where a child was found outside the classroom without supervision. This poses a potential Health and Safety risk to clients/children in care.
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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) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2019
LIC809 (FAS) - (06/04)
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