566216008-6-10-2021-17-CC-FPEA-C3URE8-20210610125707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216008
Report Date: 06/10/2021
Date Signed: 06/10/2021 12:57:14 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 CENTER		FACILITY NUMBER:	566216008
ADMINISTRATOR:	PAM MUSBURGER		FACILITY TYPE:	850
ADDRESS:	1620 HILLCREST DRIVE		TELEPHONE:	(805) 381-9081
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	122	CENSUS: 63	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Pam Musburger		TIME COMPLETED:	11:09 AM

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 10:11, 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 63 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 Infant program. Licensing required notices were posted prominently on the wall at the entrance of the facility. The preschool was using four classrooms for care. Each classroom shared a restroom with the adjacent classroom available for the children to use. LPAs did not observe any toxins/hazardous items accessible to children. The classrooms have age appropriate toys and furniture available for children. LPAs observed stored medications. LPAs observed and reviewed the posted snack menu. The center provides a morning and afternoon snack. Children bring their lunch from home. The outdoor playground has age appropriate toys and equipment. The playground has an ample amount of shade available. The center has water available for children inside and out. 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 EARLY CHILDHOOD CENTER	FACILITY NUMBER: 566216008
	VISIT DATE: 06/10/2021

NARRATIVE

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Center uses the electronic application ProCare for enrollment and communication. Parents log their children in the at the front desk when children arrive. Facility is following current COVID-19 precautions and guidelines. Children temperatures are checked when they arrive prior to being escorted to their classroom. 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 08/20/2021. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements.

Incidental Medical Services (IMS) policy was discussed and currently the center does 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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