566216007-6-10-2021-17-CC-FPEA-C3URDF-20210610125553

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216007
Report Date: 06/10/2021
Date Signed: 06/10/2021 12:56:00 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: 8	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Pam Musburger		TIME COMPLETED:	01:00 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	On June 10, 2021 at 11:10, Licensing Program Analysts (LPAs) Francisco Pedroza and Austin Rios conducted an unannounced annual inspection. LPAs met with facility Director Pam Musburger and explained the purpose of the inspection. LPAs and Director together toured the facility inside and out. The facility currently had eight children in care at the time of the inspection. The center operates from 7:00 AM to 5:00 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 two staff supervising four infants in one classroom and toddlers in the other classroom. Both classrooms had age appropriate toys and furnishings. Each classroom had changing table with sink readily accessible. LPA observed eight cribs available for infants to use with a name designation if it is being used. Facility uses cots for older infants that do not use the cribs. Food and milk is stored in a refrigerator located in the classroom. LPA reviewed a sampling of Individual needs & services plans and feeding plans. Children bottles and food were properly labeled with child's name and date. LPA did not observe any toxins/hazardous items accessible to children. Center uses the electronic application ProCare for enrollment and communication. Parents log their children in the at the front desk when children arrive. Continued on 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: ASCENSION LUTHERAN INFANT CENTER	FACILITY NUMBER: 566216007
	VISIT DATE: 06/10/2021

NARRATIVE

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Facility is following current COVID-19 precautions and guidelines. Children temperatures are checked when they arrive prior to begin escorted to their classroom. A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have current First Aid/CPR certificates that expire on 08/20/2021. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. LPAs spoke with Director about current Safe Sleep guidelines and regulations.

Incidental Medical Services (IMS) policy was discussed and currently the center does not have children with IMS. Plan of Operations on file. 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 Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC809 (FAS) - (06/04)

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