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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212889
Report Date: 06/22/2021
Date Signed: 06/22/2021 12:35:25 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:CVUSD PRESCHOOL AT CITY CENTERFACILITY NUMBER:
566212889
ADMINISTRATOR:AMIE MILLSFACILITY TYPE:
850
ADDRESS:110 S. CONEJO SCHOOL RD.TELEPHONE:
(805) 494-8100
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:104CENSUS: 38DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jacqueline LevesqueTIME COMPLETED:
12:45 PM
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On 6/22/2021 at 11:05 am Licensing Programs Analysts (LPAs) Austin Rios and Francisco Pedroza made an unannounced inspection to the facility for the purpose of conducting a REQUIRED 1-YEAR inspection. LPAs met with Site Supervisor Jacqueline Levesque and explained the purpose of the inspection. The facility operates Monday- Friday from 7:00 am-6:00 pm. Their were 38 children present. A tour of the facility was made both inside and outside.

The classrooms were observed to have age appropriate furniture/equipment. Facility has enough restrooms readily available for children in care and were observed to be clean and free of toxins. All required State forms and snack menu were posted. The playground has an ample amount of shade available and the outdoor play area is completely fenced. LPAs observed age appropriate equipment. Drinking water is provided by the facility and is available inside and outside. Due to Covid guidelines facility uses written sign-in/sign-out sheets located at the entrance where staff and children are screened for Covid-19 requirements. Teacher files reviewed and were found to be complete. Teachers have valid Pediatric CPR/First Aid which expires on 12/2022. Center staff have completed AB1207 Mandated Reporter Training. Children's files were reviewed and found to be complete.

Cont. on 809C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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: CVUSD PRESCHOOL AT CITY CENTER
FACILITY NUMBER: 566212889
VISIT DATE: 06/22/2021
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Director is reminded that they are responsible for knowing the regulations for a Child Care Center and that Licensing information can be accessed online at www.ccld.ca.gov. Facility is currently following Covid-19 requirements. LPA reviewed lead exposure requirements with Director.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

There were no deficiencies cited today.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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