566216007-9-11-2020-17-CC-MAVA-BTCW4N-20200911165747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216007
Report Date: 08/21/2020
Date Signed: 09/11/2020 04:58:50 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:	ASCENSION LUTHERAN INFANT CENTER		FACILITY NUMBER:	566216007
ADMINISTRATOR:	PAM MUSBURGER		FACILITY TYPE:	830
ADDRESS:	1620 HILLCREST DRIVE		TELEPHONE:	(805) 381-9081
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	60	CENSUS: 0	DATE:	08/21/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Pam Musberger and Caridad Greco		TIME COMPLETED:	01:00 PM

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This is a change of location, previous facility number 566210623.

Licensing Program Analysts (LPA) Michael Avila conducted a tele-visit and made an announced inspection to conduct a PRE-LICENSING change of location. LPA advised Licensee that due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection was conducted. The infant center is currently not operating. LPA met with facility Director Pam Musberger and Assistant Director Coridad Greco via FaceTime. LPA and Directors conducted a virtual tour together. The center operates from 7AM to 5PM Monday thru Friday.

A fire clearance inspection was conducted by the Ventura County Fire Department on 08/20/2020 which allows for the requested capacity of 182 children. This is a combined center with a preschool program facility number 566216008.

The center is located on local community church with a private elementary school on it's premises. A fire clearance inspection was conducted by the Ventura County Fire Department on 8/20/2020 which allows for the requested capacity of 182 combined children. Facility requested an infant license with a toddler option. They will be providing care from newborn to 24 months old. LPA observed age appropriate toys, games, tables, chairs, and equipment available for children. The classrooms had a changing table with a sink readily accessible. LPA observed cribs available for infants to use in a separate designated sleeping. Staff will always be present in the napping room when children are sleeping. Facility uses cots for older infants that do not use the cribs. Food and milk will be stored in a refrigerator located in the classroom. LPA advised Director to ensure the food and milk is properly labeled for each child in care. LPA advised to ensure each child has Individual needs & services plans and feeding plans. LPA did not observe any toxins/hazardous items that would be accessible to children. The facility has an outdoor recreation yard for the children in care.

Continued on 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

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: ASCENSION LUTHERAN INFANT CENTER	FACILITY NUMBER: 566216007
	VISIT DATE: 08/21/2020

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The recreation yard is fenced off from the facility preschool ensuring no commingling will occur. LPA observed appropriate toys and furniture available to children in care.

Classroom and Yard Measurements:
The infant center will utilize 5 classrooms with a total square footage of 3,370 feet which will allow enough room for 96 infant/toddler age children. The outdoor recreational yard measures to 1,922 feet which is more than adequate for the 60 infant/toddler age children requested for the center at this time.

LPA discussed COVID 19 prevention protocols during this virtual tele-inspection.

The center meets Title 22 Division 12 requirements.

License will be effective today, August 21,2020 for 60 infant/toddler age children.

A copy of this report was reviewed and provided to the Licensee via email. The delivered/read receipt confirmation from email will be in lieu of the signature once she received the report.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020

LIC809 (FAS) - (06/04)

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