566215756-8-20-2020-17-CC-RGUL-BSNUNM-20200820154410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215756
Report Date: 08/20/2020
Date Signed: 08/20/2020 03:46:51 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:	CAMP AMGEN		FACILITY NUMBER:	566215756
ADMINISTRATOR:	JENNIFER MCHUGH		FACILITY TYPE:	840
ADDRESS:	855 NORTH VENTU ROAD		TELEPHONE:	(805) 447-6793
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91320
CAPACITY:	28	CENSUS: 0	DATE:	08/20/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jenna Agovino,		TIME COMPLETED:	03:15 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	On 08/20/20 at 2:30pm, Licensing Program Analyst (LPA) Ruth Gull conducted a tele-video CASE MANAGEMENT inspection via FaceTime (due to the COVID-19 State of Emergency). LPA Gull met with Jenna Agovino, Operations Director, regarding the request for increased capacity (request is to increase the School Age Program capacity to 40). This is a combination center with Preschool, Infant and School Age Programs. The School Age Program is currently closed. A virtual tour and measurements of the two additional rooms, bathroom and playground was completed. The new rooms are located in the building next to the current School Age rooms. The two new rooms (Room C and Room D) each has one sink. The rooms are equipped with age appropriate furniture/toys. There is a kitchenette between the 2 rooms (separated from the rooms by safety gates) with one sink and a refrigerator. The sink has filtered water for drinking (pitcher and cups). There is a bathroom located near the classrooms (1 toilet and 1 sink) and staff will escort children to the bathroom. There is an additional playground attached to the new rooms. It has shaded areas, age appropriate toys/equipment and one sink (with filtered water for drinking). The program has a total of 3 toilets and 9 sinks which meets the requirement for 45 children. The measurements for classrooms C and D are: Classroom C: 780 square feet Classroom D: 780 square feet The total square footage of the 2 new rooms is 1560 which meets the requirement for 44 additional children The measurement of the new playground is 1696 square feet which meets the requirement for 22 additional children. CONTINUED ON LIC 809-C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth Gull	TELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

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: CAMP AMGEN	FACILITY NUMBER: 566215756
	VISIT DATE: 08/20/2020

NARRATIVE

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The Fire clearance was granted on 08/13/20 for 40 children.

The facility is licensed effective today, 08/20/20 for 40 children.

LPA Gull reviewed COVID-19 guidelines/resources with Director. Director informed LPA that they had previously completed a COVID-19 Technical Assistance tele-video inspection. LPA also reminded Director to continue monitoring the CCLD website at www.ccld.ca.gov for updates.

Exit interview was conducted with Director Agovino via FaceTime. This report will be sent to the Director via email with a read receipt or confirmation of receipt of email, which will act as the Director's signature.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth Gull	TELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

LIC809 (FAS) - (06/04)

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