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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215987
Report Date: 11/09/2021
Date Signed: 11/10/2021 12:15:59 PM

Document Has Been Signed on 11/10/2021 12:15 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:HILLCREST CHRISTIAN SCHOOLFACILITY NUMBER:
566215987
ADMINISTRATOR:CHERYL CURTISFACILITY TYPE:
850
ADDRESS:449 WILBUR ROADTELEPHONE:
(805) 495-5513
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: 85DATE:
11/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Cheryl CurtisTIME COMPLETED:
03:30 PM
NARRATIVE
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On November 9, 2021 at 10:45 AM, Licensing Program Analysts (LPAs) Francisco Pedroza conducted an unannounced Case Management inspection. LPAs met with facility Director Cheryl Curtis and advised her the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. There were 85 children in care at the time of the inspection.

On November 8, 2021, Director contacted Community Care Licensing (CCL) to report an incident that occurred on November 5, 2021. Director advised that a child was found outside in the playground alone by another staff of the facility. The child was then escorted by the staff to their classroom.

LPAs observed the video footage of the incident, measured the distance from the fence to the playground structure, record reviews, and conducted staff interviews with the staff involved in the incident. On November 5, 2021 at 11:03 AM LPAs observed C1 on Camera # 1 was playing by the fence on their side of the yard. At 11:07 AM C1 was observed slipping through/under the gate into the next yard unnoticed by staff. C1 began to play with others. At 11:09 AM C1 was observed leaving the area out of view from Camera # 1. At 11:09 AM on Camera #2, C1 came into view and was observed going to play on the playground structures. LPAs observed two parents entering through the gate and one facility member at separate times not not observing the child. At 11:31 two staff observed C1 was playing on the playground alone without supervision. They entered trough the gate and escorted at the child to another teacher. The teacher and two staff then escorted the child to the other side of the gate to their classroom. C1 was unsupervised on the playground for 24 minutes. LPAs measured the distance from the gate C1 came in from to the beginning of the playground structures which was 85,70 feet. During record reviews it was estimated there was 20 to 25 children out in the playground with three (3) to four (4) staff. C1's parent was notified on 11/5/21 at 5:20 PM when they arrived to pick up the child.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: HILLCREST CHRISTIAN SCHOOL
FACILITY NUMBER: 566215987
VISIT DATE: 11/09/2021
NARRATIVE
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Staff advised that C1 returned back to the facility on 11/8/2021. Since the incident the facility had a meeting with all staff. They implemented new precautions and accountability requirements.

On November 9, 2021 at 2:07 PM, LPAs determined that there was an Absence of Supervision for 24 minutes. Staff interviews and statements confirmed that they were unaware C1 was missing until they were escorted back to the playground. Director advised that she understood. LPAs advised California Code of Regulations, (Title 22, Division 12) 101229(a)(1) Responsibility for Providing Care and Supervision will be cited.

A closing interview was conducted with Director Cheryl Curtis. Director was provided and advised of their right to appeal. A copy of this report was provided to the Director. Director advised that it is a posting requirement. Each parent is required to receive a copy of the report and sign a LIC 9224 to be place in their child's file on next day their child is brought to the facility.

One type A deficiency was cited during today's inspection.

Notice of site visit posted.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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Document Has Been Signed on 11/10/2021 12:15 PM - It Cannot Be Edited


Created By: Francisco Pedroza On 11/09/2021 at 02:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HILLCREST CHRISTIAN SCHOOL
FACILITY NUMBER: 566215987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/23/2021
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision ... to meet the children's needs.
(1) No child(ren) shall be left without the supervision ... shall include visual observation.
This requirement was not met evidence by:
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Facility director will submit a written plan of correction (POC) stating measures to be taken in order to follow Title 22 Regulations and avoid another incident like this happening again. Director advised an informal conference will be scheduled on November 16, 2021 at 10:00 AM. Directors POC will be due on that day.
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Based on LPAs observations, interviews, and records. The facility failed to supervise a child resulting in an Absence of Supervision in another playground for 24 minutes. This poses an immediate Health and Safety risk to persons/children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2021


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