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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216107
Report Date: 04/15/2021
Date Signed: 04/28/2021 04:03:12 PM

Document Has Been Signed on 04/28/2021 04:03 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:ADVENTIST EDUCATION SIMI VALLEY PRESCHOOLFACILITY NUMBER:
566216107
ADMINISTRATOR:TAMMY GRODTFACILITY TYPE:
830
ADDRESS:1636 SINALOA ROADTELEPHONE:
(805) 210-8353
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/15/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Tammy GrodtTIME COMPLETED:
03:30 PM
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This is an Amended report from 4/15/2021.

On April 15, 2021, at 1:30 PM Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced tele-inspection for the purpose of completing a pre licensing inspection. Due to COVID-19 and the Department of Public Health guidelines, LPA conducted the tele-inspection via Facetime. LPA met with Director Tammy Grodt and explained the nature and the purpose of the inspection. Director Grodt provided LPA a tour of the facility inside and out. This is a combined center with a Preschool component. There were no children in care a the time of the inspection.

The center is located a local church grounds. Facility received an approved fire clearance from the Ventura County Fire Department on 04/08/2021. LPA observed licensing required notices posted prominently in the entrance of the facility. The facility is requesting a infant license with a toddler option. The facility will be using three classrooms for infant/toddlers in care. One classroom is split into two separate classrooms with a divider in middle creating an infant classroom on one side and toddler classroom on the other side. The classrooms had age appropriate toys and furnishings. LPA observed three sinks with a changing table within one arm reach readily accessible to each sink. LPA observed 12 cribs for infants and cots available for the older infants that do not use cribs. LPA reviewed safe sleep practices with Director. Food and milk will be stored in refrigerator located in the classroom. LPA advised Administrator to ensure the food and milk is appropriately labeled with the child's name and date. LPA advised Administrator to ensure every infant has an updated needs and services plan for care. LPA did not observe any toxins/hazardous items accessible to children in care.

The children have their own outdoor playground. The infants and toddlers individual sections. The outdoor playground has age appropriate toys and furniture available for children.

Continued 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2021
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: ADVENTIST EDUCATION SIMI VALLEY PRESCHOOL
FACILITY NUMBER: 566216107
VISIT DATE: 04/15/2021
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The playground has an ample amount of shade available. The center has water available for the children inside and out. LPA spoke with Director about Covid-19 precautions and current guidelines.

Facility Measurements:
Indoor 1,437 Square Feet meets the requirement for 30 infant/toddlers.
Outdoor 2,897 Square Feet meets the requirement for 30 infant/toddlers.

The center meets Title 22 Division 12 requirements.

License will be effective today, April 15, 2021 for 30 infant/toddlers.

An exit interview was conducted with Director Grodt. A copy of this report was reviewed and provided to Director who agree to receive a copy of the report via email and voiced understanding that the read receipt confirmation from email will be in lieu of her signature once she received the report. LPA requested Director provide a signed copy of the report so it can be placed in the facility file.

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: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC809 (FAS) - (06/04)
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