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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212889
Report Date: 04/08/2022
Date Signed: 04/08/2022 08:36:27 AM


Document Has Been Signed on 04/08/2022 08:36 AM - 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: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: 3DATE:
04/08/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Bonnie BaruchTIME COMPLETED:
09:00 AM
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On April 8, 2022 at 8:15 AM, Licensing Program Analysts (LPA) Dean Thompson conducted an unannounced Case Management – COVID-19 inspection and met with Site Supervisor Bonnie Baruch and Program Specialist Jaqueline Levesque. LPA informed Bonnie and Jaqueline the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. LPA was given a tour of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by the facility staff to CCL between 1/6/2022 - 2/7/2022). CCL provided a Tele - Rapid Assistance Support Team (RAST) inspection on July 21, 2020 where an LPA provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA observed facility staff wearing masks inside the facility. Mask and sanitizer is available throughout the facility, hand washing safety posters were posted, and gloves are available.

LPA was given the facility’s COVID -19 Safety Plan for when a staff member or child tests positive for COVID-19. LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing,, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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: 04/08/2022
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LPA also provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Bonnie Baruch

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

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC809 (FAS) - (06/04)
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