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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213560
Report Date: 02/22/2022
Date Signed: 02/22/2022 12:53:30 PM


Document Has Been Signed on 02/22/2022 12:53 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:FREDRICKSON FAMILY EARLY CHILDHOOD CENTERFACILITY NUMBER:
566213560
ADMINISTRATOR:KATHRYN DEANFACILITY TYPE:
830
ADDRESS:3450 CAMPUS DR.TELEPHONE:
(805) 493-3247
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Yvanna HerreraTIME COMPLETED:
12:55 PM
NARRATIVE
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On February 22, 2022 at 9:53 AM, Licensing Program Analyst (LPA) Dean Thompson and Licensing Program Manager (LPM) George Mingle conducted an unannounced Annual/Random Inspection. LPA met with Yvanna Herrera and informed her the reason for the inspection. Director was unavailable at the time of visit and LPA observed form LIC 308 which designates Yvanna Herrera to be in charge. Before entering the facility, LPA conducted covid pre-screening questions to make sure no one inside the facility has tested positive for covid or have any flu like symptoms. Yvanna gave LPA a tour inside and outside of the facility. During the time of inspection there were five infants in care.

LPA observed required licensing documents mounted on the wall inside the lobby. LPA observed the center menu schedule which the facility provides snacks in the morning and afternoon. Fire drills were being conducted every six months. Last fire drill was completed on 9/23/2021. Children bring their own lunch from home. The center has one classroom available for infants. LPA did not observe any hazards/toxins items accessible to children in care. The classroom has age-appropriate toys and furniture readily accessible for children in care. Facility provides cribs during quiet time if they choose to sleep. The outdoor playground 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. The playground has ample amount of shade available. The facility has water available for children inside and out.

A sampling of children and staff records were reviewed. LPA observed children's files to be incomplete. LPA observed all children files who were sign in today missing LIC 627 Consent for Emergency Medical Treatment. Currently the facility does not have infants that require Incident Medical services (IMS).


Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
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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Document Has Been Signed on 02/22/2022 12:53 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: FREDRICKSON FAMILY EARLY CHILDHOOD CENTER
FACILITY NUMBER: 566213560

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 facility did not ensure staff (S2) complete the mandated reporter training every two years as required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2022
Plan of Correction
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Facility representative agreed to have staff complete the training by Plan of Correction (POC) due date at www.mandatedreporterca.com Have to do the General Training first. Then choose Child Care training (AB1207) Take final exam.
Once completed, send proof to LPA via email or text.
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review of five children files reviewed today, none of the files had LIC 627 consent for emergency medical treatment form completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2022
Plan of Correction
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Facililty representative agreed to have all children files complete with form LIC 627 consent for emergency medical treatment by Plan of Correction (POC) due date.

Proof of completion to be sent via email or text.

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: 02/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: FREDRICKSON FAMILY EARLY CHILDHOOD CENTER
FACILITY NUMBER: 566213560
VISIT DATE: 02/22/2022
NARRATIVE
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LPA observed staff files to be incomplete. Staff (S2) is missing the Mandated Reporter Training Certification. The staff member certification expired 8/24/2019 and failed to provide a current certification. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. CPR certification is current until 02/2022.

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 follow 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.

Representative 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.

Two Type B deficiency was cited for the Mandated Reporter Certification and Consent for Emergency Medical Services. Plan of correction was discussed.

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, appeal rights were given, and report was reviewed with the facility representative Yvanna Herrera.

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

DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022
LIC809 (FAS) - (06/04)
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