<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216130
Report Date: 08/23/2024
Date Signed: 08/23/2024 11:00:23 AM

Document Has Been Signed on 08/23/2024 11:00 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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
566216130
ADMINISTRATOR/
DIRECTOR:		KATHERINE STEVENSFACILITY TYPE:
850
ADDRESS:28370 ROADSIDE DRIVETELEPHONE:
(818) 889-9841
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 15DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Director Tiffany HouseTIME VISIT/
INSPECTION COMPLETED:
11:09 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/23/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with Center Director Tiffany House and Assistant Director Maricela Garcia and informed them the purpose for todays inspection. Today, LPA did a walk through of the Child Care Center with the Center Director. LPA observed at the time of the walk-through 15 children being supervised by 5 staff.

On 06/05/2024, Director Tiffany House contacted Community Care Licensing (CCL) to self-report the following unusual incident : At approximately 4:25PM C1, C2 and other children were playing at a play structure in a tunnel and C2 pulled on C1's arm inside the tunnel. C1 started crying. C1 ran up to the staff. Staff applied ice and the assistant director called mother of C1. Parent took C1 to urgent care(Exer Urgent Care). It was determined C1 received a dislocated elbow. As of 6/5/2024 C1 returned with no cast. No doctors note. The ratio at the time of the incident was 29 children with 3 teachers providing care and supervision.

The Unusual Incident Report (LIC624) was received via email on 6/6/2024 . The LIC624 provided details on the administrative action the preschool program took and information on the urgent care facility.

Continued-809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 566216130
VISIT DATE: 08/23/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Today LPA conducted Children's file review and staff interviews which confirmed multiple similar unusual incidents have occurred in the past 20 months. One incident occurred on 5/1/2023. A second incident occurred on 4/20/2023. A third incident occurred on 12/06/2022 and the fourth incident occurred on 06/04/2024. All four incidents are under review by the department.

LPA has requested staff roster, children’s roster (of current and previously enrolled staff). Also, LPA requested copies of the LIC624 for the aforementioned unusual incidents.

Due to insufficient information, the investigation is ongoing.

No deficiencies are being cited today.


Exit interview was conducted, report reviewed, and copy was provided to Center Director. Notice of site visit was given.

THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2