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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215196
Report Date: 03/09/2022
Date Signed: 03/09/2022 03:17:28 PM

Document Has Been Signed on 03/09/2022 03:17 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:PHOENIX RANCH SCHOOL & CAMP (WEST CAMPUS)FACILITY NUMBER:
566215196
ADMINISTRATOR:VICTORIA DE LEONFACILITY TYPE:
850
ADDRESS:4974 COCHRAN AVE.TELEPHONE:
(805) 527-7764
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 225TOTAL ENROLLED CHILDREN: 205CENSUS: 111DATE:
03/09/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Victoria De LeonTIME COMPLETED:
03:30 PM
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On March 9, 2022 at 2:39 PM, Licensing Program Analysts (LPA) Dean Thompson and Michael Mathew conducted an unannounced Case Management – COVID-19 inspection and met with center director Victoria De Leon. LPA informed the director the purpose for the inspection and completed a COVID-19 pre-screening questions prior to the commencement of the inspection. LPA was given a tour of the facility, inside and outside.

This inspection is a follow-up on COVID-19 outbreaks reported by facility staff to CCL between 1/24/2022 - 2/23/2022). CCL provided a Tele - Rapid Assistance Support Team (RAST) inspection in July 2020, where an LPA provided COVID-19 resources, current Childcare Industry Guidance, and a COVID-19 self-assessment guide to the facility.

LPA provided facility with a Covid 19 Child Care Program Self-Assessment Guide form which needs to be complete and submitted by March 23, 2022 to LPA via email.

LPA observed facility staff wearing masks inside the facility. Before entering the facility covid pre-screening questions were asked, sanitizer is available throughout the facility, COVID - 19 safety posters were posted..

LPA was given the facility’s COVID -19 updated School Year plan for when a staff member or child tests positive for COVID-19. LPA discussed COVID-19 Vaccines, Testing, Face coverings, Essential Protective Equipment and Supplies, Physical Distancing, Ventilation, Isolation for Illness, Cleaning and Disinfection, Hand washing, How to Respond to Exposures or Outbreaks, and Resilience Tips during the Pandemic.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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: PHOENIX RANCH SCHOOL & CAMP (WEST CAMPUS)
FACILITY NUMBER: 566215196
VISIT DATE: 03/09/2022
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LPA reviewed that facility maintains a current Covid-19 Child Care Program Self-Assessment Guide/Mitigation plan. LPA also provided the following resources:
- Official Public Health and Child Care Guidance for COVID-19 – Updated 1/26/2022.
- COVID-19 Child Care Resources:
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources

There were no deficiencies cited during today's inspection.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with assistant director Victoria De Leon.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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