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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216180
Report Date: 09/10/2021
Date Signed: 09/10/2021 09:56:07 AM

Document Has Been Signed on 09/10/2021 09:56 AM - 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:CDR - RANCHO CAMPANA CENTERFACILITY NUMBER:
566216180
ADMINISTRATOR:DARLENE GOODRICHFACILITY TYPE:
850
ADDRESS:4235 MAR VISTA DR.TELEPHONE:
(805) 826-4156
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Darlene GoodrichTIME COMPLETED:
10:00 AM
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On 9/10/21, at 8:00 AM, Licensing Program Analyst (LPA) Betzayra Cervantes and Licensing Program Manager (LPM) George Mingle made an announced pre-licensing inspection to the Child Care Center (CCC). Prior to entering the CCC, LPA conducted a pre-screening COVID-19 questionnaire and based on Applicant's responses it was determined that there are no COVID-19 exposures in the facility. LPA and LPM met with Director of Early Care and Education Programs Suzanne Godinez, Early Childhood Assistant Manager Cindy Ayala, and Site Supervisor Darlene Goodrich. LPA explained the purpose of the inspection. There were no children present in the facility at the time of the inspection.

Children's Development Resources - Rancho Campana Center submitted an application for Preschool Child Care Center with a capacity of fourty (40) children. This CCC will be operating from August through June from 8AM - 2PM. This CCC is located on the premises of Rancho Campana High School. This CCC was toured inside and outside. Center will have two (2) classrooms, "G" and "F". CCC has one (3) toilets and three (3) sinks which will be shared by the two classrooms found in sanitary and working condition.

Indoor and Outdoor area measurements meet requested capacity of 40 children. LPA observed CCC is clean, safe, sanitary with plenty of learning activities for the children in care. Center has age-appropriate equipment for preschool age children. Breakfast, lunch, and snack will be provided by the center. LPA and LPM inspected the kitchen where food is prepared and was observed to be clean and food items were properly stored and labeled. Families will sign in and sign out electronically at the facility during drop off and pick up. LPA observed carbon monoxide detector and smoke detector in the CCC.

CONT 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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: CDR - RANCHO CAMPANA CENTER
FACILITY NUMBER: 566216180
VISIT DATE: 09/10/2021
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LPA observed the outdoor play area to be completely fenced with large play structure in good condition. Outdoor play area is safe, clean and free of potential hazards. Center provides drinking water in a cooler and disposable water cups inside and outside the classrooms. LPA did not observe any bodies of water.

LPA observed the following Licensing forms posted: Emergency Disaster Plan (LIC 610), Parent's Rights Poster (PUB) 393, Personal Rights (LIC613A), Child Car Seat Law, and Menu.

Site Supervisor has CPR/First Aid which expires on 03/06/2022. Site Supervisor's Mandated Reporter Training expires 08/11/2023. LPA reviewed Director's immunization requirements and transcripts.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

During the course of the inspection, LPA discussed COVID-19 Mitigation plan, best practices, and the implementation of such in the Center. Fire Clearance was granted by the Ventura County Fire Department on 09/08/2021.

License approved for a capacity of 40 children effective today, September 10, 2021.

Exit interview and a copy of this report was reviewed and provided to the Site Supervisor, Darlene Goodrich.



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.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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