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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216469
Report Date: 11/14/2022
Date Signed: 11/16/2022 12:44:03 PM

Document Has Been Signed on 11/16/2022 12:44 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:SEGRAY AT THE OAKSFACILITY NUMBER:
566216469
ADMINISTRATOR:ANNETTE GLADSTONEFACILITY TYPE:
850
ADDRESS:3277 FOOTHILL BLVD.TELEPHONE:
(949) 500-4272
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91361
CAPACITY: 124TOTAL ENROLLED CHILDREN: 124CENSUS: DATE:
11/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Annette Gladstone & Stee HellerTIME COMPLETED:
11:45 PM
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On November 14, 2022 at 9:40 AM, Licensing Program Analyst (LPA) Susana Martinez conducted an announced pre-licensing inspection for change of ownership. LPA met with administrators Annette Gladstone and Steve Heller and discussed the purpose for the inspection. Prior to entering the facility LPA conducted a COVID-19 risk assessment, all answers indicate there is no exposure to COVID-19 present. Administrators and LPA toured the facility inside and outside. At the time of the inspection there were 82 children and 14 staff members present.

No bodies of water were present at the time of the inspection. The facility plans to serve children ages 2 years old- enrollment to Kindergarten and plans to operate Monday- Friday 7:30 AM- 5:00 PM. Administrator’s state AM/PM snacks and lunch will be provided. LPA observed the kitchen to be clean and in working condition.

LPA observed sufficient age appropriate toys and learning material throughout the facility. No hazards/toxins were observed to be accessible to the children in care. LPA observed first aid kits throughout the facility. The facility will be occupying 10 rooms for care which are numbered 1-10. The facility will also be using the outside space directly behind classrooms 5-9 and the outside space behind classrooms 5-4. The facility has a total of 8 children's stalls and 8 sinks.

A fire clearance was granted by the Ventura County Fire Department on 11/04/22.

LPA provided and reviewed with Site Supervisor the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed information capacity, ratios, current Covid-19, and safe sleep requirements. Site Supervisor was made aware that it is the facility's responsibility to know the current regulations for a CCC which can be accessed on-line at www.cdss.ca.gov.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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: SEGRAY AT THE OAKS
FACILITY NUMBER: 566216469
VISIT DATE: 11/14/2022
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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

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.


The center meets Title 22 Division 12 requirements. License will be effective today, 11/14/2022 for total capacity of 115 children.


Exit interview was conducted, appeal rights were given, and report was reviewed with the Steve Heller.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC809 (FAS) - (06/04)
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