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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216008
Report Date: 08/21/2020
Date Signed: 09/11/2020 04:59:31 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 EARLY CHILDHOOD CENTERFACILITY NUMBER:
566216008
ADMINISTRATOR:PAM MUSBURGERFACILITY TYPE:
850
ADDRESS:1620 HILLCREST DRIVETELEPHONE:
(805) 381-9081
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:122CENSUS: DATE:
08/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Pam Musberger and Coridad GrecoTIME COMPLETED:
11:00 AM
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This is a change of location, previous facility number 561700012.

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 preschool 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. The facility has second licensed facility on the premises Ascension Lutheran Infant Center facility number 566216008.

LPAs observed age appropriate toys, games, tables, chairs, and equipment available for children. Children will be provided one snack during their time at the facility. Children will provide their own lunch. The center will have snacks available for the children. Continued on 809C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (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 EARLY CHILDHOOD CENTER
FACILITY NUMBER: 566216008
VISIT DATE: 08/21/2020
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Water fountains are located in each classroom and outdoor area. LPA observed shade is provided to the children via an open hallway along the exterior of the building. A play structure was observed in the playground for children ages 2-6 yrs old. The entire outdoor play yard is secured with a gated fence.

The center has 7 classrooms dedicated to the preschool age children with a total square footage of 5,061 allowing the center to accommodate up to 144 preschool children. There are restrooms found in each classroom with a total of 9 toilets. LPA observed a sink in each restroom and in each classroom for a total of 14 sinks. The center requested and is only authorized to accommodate 122 children.

The center meets Title 22 Division 12 requirements.

License will be effective today, August 21,2020 for 122 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 MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (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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