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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216007
Report Date: 09/11/2024
Date Signed: 09/11/2024 02:13:59 PM

Document Has Been Signed on 09/11/2024 02:13 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ASCENSION LUTHERAN INFANT CENTERFACILITY NUMBER:
566216007
ADMINISTRATOR/
DIRECTOR:		JENNIFER MCCOYFACILITY TYPE:
830
ADDRESS:1620 HILLCREST DRIVETELEPHONE:
(805) 381-9081
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 36DATE:
09/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Jennifer McCoyTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 09/11/24 Licensing Program Analyst (LPA) Veronica Diaz conducted an unannounced Required-3 Year inspection. LPA met with director Jennifer McCoy and advised them of the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 36 infants in care at the time of the inspection along with 10 staff. Center operates M-F 7:00AM-5:00 PM.

LPA observed required licensing documents at the front desk in the entrance of the facility. Last fire drill was conducted on 09/05/24 Licensing requires it done every 6 months center conducts fire drills every month. Each of the classrooms have age-appropriate toys and furniture. LPA observed enough cribs available for infant use. LPA did not observe any items in the cribs besides the mattress and fitted sheets. Each infant is provided a crib and is labeled with their name, fitted sheets are provided by the center and washed daily. Center has a laundry room on site. LPA did not observe any hazards/toxins items accessible to children. First Aid kits were observed throughout the facility each classroom has a backpack safety kit. Currently the facility uses an App called Procare for sign-in and sign-out, documentation, pictures, and a form of communication to staff and parents. Facility does not provide snacks or formula/lunch. Snacks and formula/lunch is provided from home.

The outdoor playground is shaded and has an ample amount of space for infants to play. LPA observed the playground has age-appropriate toys and structures available for children to use.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Staff mandated reporter certification are all current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements.

Continued on 809-C
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ASCENSION LUTHERAN INFANT CENTER
FACILITY NUMBER: 566216007
VISIT DATE: 09/11/2024
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ASCENSION LUTHERAN INFANT CENTER
FACILITY NUMBER: 566216007
VISIT DATE: 09/11/2024
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Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name).
No deficiencies were cited.
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
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