<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214418
Report Date: 03/10/2020
Date Signed: 03/10/2020 01:44:49 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: 43DATE:
03/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Kristina GolemTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Michael Avila made an Unannounced CASE MANAGEMENT visit to the center regarding Licensee's request for a Toddler Component. LPA Avila met with Licensee Kristina Golem and toured/measured the existing indoor and outdoor space. The Licensee is requesting a change in capacity for 15 additional toddler age children, however outdoor space will only allow 8 toddler children. The Preschool has a capacity of 75 and the Toddler Component will add 8 more. Licensee will facilitate the toddler component in a room in a separate building located just across the the preschool facility. Licensee provided proof of control of property and a fire clearance was approved by the Ventura Fire Department on March 4, 2020. There is a changing table and 1 toilet and 3 sinks in the classroom. The playground is attached to the preschool center accessed through a private gate and has age appropriate toys and equipment. The outdoor area has adequate cushioning material. LPA reviewed the regulations for Infant Care (which are part of the Preschool Program with a Toddler Component) with Licensee Kristina Golem.

The center is licensed with a Toddler Component for 8 children effective today, March 10, 2020.

No deficiencies were cited during today's visit.

The LIC9213 (Notice of Site Visit) was posted during the visit.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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 1