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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215214
Report Date: 05/31/2019
Date Signed: 05/31/2019 11:54:16 AM

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:PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)FACILITY NUMBER:
566215214
ADMINISTRATOR:VICTORIA DE LEONFACILITY TYPE:
830
ADDRESS:4974 COCHRAN AVE.TELEPHONE:
(805) 527-7764
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:20CENSUS: 0DATE:
05/31/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Victoria De LeonTIME COMPLETED:
10:30 AM
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Licensing Program Analyst's (LPAs) Francisco Pedroza and Jill Laxo conducted an unannounced Annual Random Inspection at the center. LPAs Pedroza and Jill Laxo met with Director Victoria De Leon and explained the purpose of the visit. This is a combination Infant and Preschool program. The center shares the property with a private elementary school. The center operates Monday - Friday from 6:30am to 6:30pm. There were no children in care at the time of the inspection.

A tour of the Infant component was made both inside and out. The facility uses two classrooms for the infants. Both classrooms have age appropriate toys and furnishings. Both classrooms share a bathroom with two toilets and three sinks. Each classroom has a changing table with a sink readily accessible. LPAs reviewed a sampling of Individual needs & services plans and feeding plans. Children bottles and food are label with child's name and date. LPAs did not observe any toxins/hazardous items accessible to children. The playground has age appropriate toys and equipment. Their is no commingling between Infant and preschool children. There is drinking water available both inside and out.

LPAs reviewed parent sign in/out sheets. Continued on 809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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 2
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: PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)
FACILITY NUMBER: 566215214
VISIT DATE: 05/31/2019
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A sampling of children and staff records were reviewed. Infant teachers have required qualifications. Teachers present have current First Aid/CPR certificates with an expiration of 05/18/2021. LPAs reviewed SB 792 Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements. AB 1207 Mandated Reporter Training certificates were current with an expiration date of 03/30/2020. Director was provided a guide for Safe Sleep and effects of Lead Exposure brochures.

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 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

No deficiencies were cited during today's visit.



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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
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