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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215191
Report Date: 06/23/2022
Date Signed: 06/23/2022 02:57:25 PM

Document Has Been Signed on 06/23/2022 02:57 PM - It Cannot Be Edited

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:CHILDREN'S HAVEN SCHOOL AGE PROGRAM, THEFACILITY NUMBER:
566215191
ADMINISTRATOR:KIMBERLY MCCOWANFACILITY TYPE:
840
ADDRESS:38 TELOMA DR.TELEPHONE:
(805) 644-7722
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 15DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Destiny AlvarezTIME COMPLETED:
03:10 PM
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On June 23, 2022 at 1:42 PM, Licensing Program Analysts (LPA's) Francisco Pedroza and Susana Martinez conducted an unannounced Annual/Random inspection. LPA's met with facility Director Destiny Alvarez and advised her the purpose of the inspection. Prior to conducting the inspection, LPA's conducted Covid-19 pre screening questions. Director provided LPA's a tour of the facility inside and out. There were 15 children in care and four (4) staff at the time of the inspection.

LPA's observed required documents posted prominently on the wall at the entrance of the facility. Facility has only one (1) large room for the children in care. They have enough restrooms readily accessible for children in care. The center provides two (2) snacks for children in care during their Summer program. Children bring their lunch from home. LPA's observed toys, activities and furniture readily accessible for children to use. The center take children on different field trips. The center uses an outdoor grass area for children to play. LPA's observed the center has enough shade readily available for the children. The center provides water to children inside and out. Children are provided a disposable water cup.

Facility uses the electronic application Procare for sign-in/sign-out. LPA's reviewed a sampling of children and staff files. Children files reviewed were found to be current. Staff files reviewed were found to be current. Facility staff meet the CPR/First-aid and Mandated Reporter requirements. Facility is following current Covid-19 requirements.

No deficiencies were cited during today's inspection.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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: CHILDREN'S HAVEN SCHOOL AGE PROGRAM, THE
FACILITY NUMBER: 566215191
VISIT DATE: 06/23/2022
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Incidental Medical Services (IMS) policy was discussed. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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