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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216436
Report Date: 09/21/2023
Date Signed: 09/21/2023 10:51:55 AM


Document Has Been Signed on 09/21/2023 10:51 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:PACIFIC CAMPS FAMILY RESOURCE INC.FACILITY NUMBER:
566216436
ADMINISTRATOR:KENNETH HARLEYFACILITY TYPE:
840
ADDRESS:4050 MARKETTELEPHONE:
(805) 445-9469
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:90CENSUS: 0DATE:
09/21/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Heather ElkinsTIME COMPLETED:
10:52 AM
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On September 21st, 2023, at 10:00AM Licensing Program Analyst (LPA) Rosie Breault conducted an announced Case Management inspection. Licensee applied to add additional rooms for care and supervision. LPA met with Director Heather Elkins and advised her of the purpose of the inspection. Licensee provided LPA a tour of the facility. At the time of the inspection there were zero children present. The hours of operation are Monday through Friday 7:00am – 6:00pm

This facility is currently licensed as a School Aged Day Care Center with a capacity of 90 children. Licensee did not request a change of capacity; however, requested to add three additional rooms to the license: 2 (two) sanctuary rooms (upstairs and down) and one (1) foyer. On the first floor there is one (1) room labeled Sanctuary, with upstairs leading to second Sanctuary room which both will be used for TK – 8th grade children. LPA observed second story room to have a guard rail roughly 3.5 feet high. Licensee stated children will have limited access to this room. LPA advised licensee to add additional barrier to reach at least 4 feet in height. LPA observed one (1) foyer at the entrance of the Sanctuary. Licensee stated accessible to children; however, children will not be playing in foyer but the entrance to the bathroom is located off the side of the foyer. LPA observed absence of carbon monoxide detectors and fire extinguishers expired on 9/15/2023.
Ventura City Fire Department conducted an inspection on 09/19/2022 and was approved for use of additional three rooms.

Final licensing determination pending manager approval, and submission of: photographic evidence of additional barrier, and fire extinguisher and carbon monoxide purchase receipts.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817.
SUPERVISOR'S NAME: Deborah LoweTELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023
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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