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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216130
Report Date: 09/10/2024
Date Signed: 09/10/2024 11:28:43 AM

Document Has Been Signed on 09/10/2024 11:28 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: DATE:
09/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:TiffanyTIME VISIT/
INSPECTION COMPLETED:
11:42 AM
NARRATIVE
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On 09/10/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of completing a Case Management - Incident inspection that was initiated on 8/23/2024. Today LPA met with Center Director Tiffany House. Today, LPA did a walk through of the Child Care Center(CCC) with the Center Director. LPA observed at the time of the walk-through 30 children being supervised by 6 staff.

The purpose of the case management inspection was initiated due to a incident that occurred on 06/04/2024. Director Tiffany House contacted Child 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.

During the course of the investigation/review LPA conducted children’s file review, staff interviews, staff handbook review and LPA interviewed multiple parents of former and currently enrolled children. Also the investigation included two unannounced visits and photographs of the CCC play structures. Continued on LIC809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 566216130
VISIT DATE: 09/10/2024
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 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.

A fifth unusual incident was reported to CCL on 9/06/2024 by the director via telephone call, the director stated the following: approximately 8:30AM, C7 was seated on a picnic table bench with other 4 children when C7 stood up on the bench, tried to turn around and lost coordination/balance. C7's face struck the metal bench attached to the table, causing an injury to C7's lower lip. According to the reporting party, C7 bit lower lip as face/chin struck the bench. The Unusual Incident Report(LIC624) was received today , 9/09/2024 via email. C7 returned on 9/9/2024 with no doctors note.

All five unusual incidents were under investigation/review by CCL.

LPA conducted parent interviews. The parent interviews revealed how all parents are happy with the care and supervision at the aforementioned center. Most parents stated they would recommend the child care center. All the parents that were interviewed confirmed they have observed the play structures and all parents believe the play structures are safe.

LPA reviewed Employee Handbook. LPA verified the Employee Handbook gives professional guidance to staff when providing care and supervision. In particularly on page 21 of the Employee Handbook it reads " appropriate employee conduct includes but not limited to the following guideline...Following all company and licensing guidelines related to safety at all times. Continued on LIC809-C

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

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 566216130
VISIT DATE: 09/10/2024
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Furthermore LPA received and reviewed employee orientation training guide. This document provides guidance to all new employee as they register and complete multiple courses. LPA verified all new employees are mandated to take on a supervision course, which explains tools and strategies on how staff can effectively supervise children.

LPA conducted staff interviews, during interviews LPA discovered all five incidents had the appropriate ratios as outlined in Title 22 California Code of Regulations. During the director interview, director stated the staff still encourage children not to run on the pavement in order to reduce the probability of children tripping and receiving a injury.

This concludes CCL investigation/review.

Exit interview conducted with the Director.

Notice of site visit was provided.

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: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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