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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214418
Report Date: 02/21/2020
Date Signed: 02/21/2020 04:11:51 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:NEWBURY OAKSFACILITY NUMBER:
566214418
ADMINISTRATOR:TANYA MEZAFACILITY TYPE:
850
ADDRESS:340 VIA LAS BRISAS #110TELEPHONE:
(805) 376-5500
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY:75CENSUS: 64DATE:
02/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kristina GolemTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Avila conducted an unannounced Case Management Inspection. LPA Avila met with Licensee Kristina Golem and discussed the nature and purpose of the visit. While touring the facility, LPA Avila observed 2 toddlers (C1 & and C2) under the age of 2yrs old, in care of S1 in a classroom located outside the facility. The room, identified as the "Enrichment Center" is an area Licensee utilized to conduct class projects. The "Enrichment Center" room is also used to care for infants separate from the preschool children in care. In review of records, LPA noted the "Enrichment Center" room was not included in the facility floor sketch (LIC 999) nor included in the fire clearance inspection on 10/31/2014. Licensee advised the "Enrichment Center" room was initially utilized as an area strictly used for parents and teachers to engage in class projects with children enrolled in the facility. The use of the "Enrichment Center" room eventually transformed into a regular area used by the facility as an extension of the child care center.

LPA Avila advised Licensee in order to continue to operate and care for children in the room identified as the "Enrichment Center", Licensee would need to submit a new facility sketch (LIC 999) and undergo a fire inspection. Licensee was also advised their facility license restricts care of children between the ages of 2-6 years of age. Licensee must either apply and obtain approval of an Infant care license to care for infants between 0-24 months or approval of a toddler option of 18 months through 36 months.

Due to the room not having been cleared with a fire inspection prior to caring for children in care, the following type "A" deficiency under C.C.R., Div. 12. Title 22 regulation : 101161(a) Limitations on Capacity and Ambulatory Status, on the attached LIC 809D page.

Licensee was provided with a copy of appeal rights. This report must be posted for 30 days. Licensee is to provide a copy of this report to each parent/legal guardian of every child for the next 12 months. Every parent/guardian must sign and date a LIC 9224 "Acknowledgment of Licensing Reports" and the copies of the reports.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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: NEWBURY OAKS
FACILITY NUMBER: 566214418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2020
Section Cited

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101161(a) Limitations on Capacity and Ambulatory Status states: A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This regulation was not met as evident on 2/21/2020 while conducting an inspection.
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At/or around 12pm, LPA Avila observed the use of a classroom outside of the licensed facility being utilized as an area caring for 2 toddlers (C1 & C2) under the care of a staff teacher (S1). The room had not undergone a fire inspection clearance which presents an immediate threat to the 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: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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