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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215214
Report Date: 06/16/2021
Date Signed: 06/16/2021 11:10:54 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: 9DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Victoria De LeonTIME COMPLETED:
10:15 AM
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On June 16, 2021 at 9:40 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Austin Rios conducted an unannounced Annual/Random inspection. LPAs met with facility Director Victoria De Leon and explained the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. The facility currently had nine (9) children in care at the time of the inspection. The center operates from 7:00 AM to 6:00 PM, Monday thru Friday. This is a combined center with an preschool program.

Licensing required notices were posted prominently on the wall at the entrance of the facility. There were three staff supervising the nine infants in the classroom. The one classroom had age appropriate toys and furnishings. The classroom had a changing table with sink readily accessible. LPAs observed enough cribs for the infants in care. Facility had the required and current sleep logs on the wall. Food and milk is stored within two refrigerators located in the classroom. Children bottles and food were properly labeled with child's name and date. LPAs reviewed a sampling of Individual needs & services plans and feeding plans. LPA did not observe any toxins/hazardous items accessible to children.

Continued on 809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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: PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)
FACILITY NUMBER: 566215214
VISIT DATE: 06/16/2021
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Center uses the electronic application Brightwheel. A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have current Pediatric First Aid/CPR certificates that expire on 5/8/2023. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 10/5/2022. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Facility is following current Covid-19 and Safe Sleep guidelines.

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: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
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