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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566217141
Report Date: 03/02/2026
Date Signed: 03/02/2026 01:18:02 PM

Document Has Been Signed on 03/02/2026 01:18 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:DUAL IMMERSION ACADEMY OF CALIFORNIAFACILITY NUMBER:
566217141
ADMINISTRATOR/
DIRECTOR:		FERNANDEZ, GEORGINAFACILITY TYPE:
860
ADDRESS:30105 AGOURA ROADTELEPHONE:
(805) 851-0130
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 17DATE:
03/02/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Georgina FernandezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 3/02/2026, at 9:00 AM PST, Licensing Program Analyst (LPA) Seena Parsapour conducted an unannounced Annual/Random Inspection of the above-mentioned Child Care Center (CCC). LPA met with Director Georgina Fernandez and explained the nature & purpose of the inspection. LPA, in the company of Director, toured the interior and exterior of the CCC in its entirety. The CCC utilizes four (4) classrooms and an outdoor play area for child care purposes. The CCC operates between 7:30 AM to 5:30 PM, Monday through Friday. At the time of the inspection, LPA observed seventeen (17) children in care, along with five (5) staff members providing care and supervision.

LPA observed required licensing documents posted in the hallway of the CCC. The CCC uses electronic sign in/sign out logs via the Brightwheel application. LPA notes the application contains the children’s arrival and departure times as well as entries of the authorized representatives/parents. The CCC is clean and orderly. LPA observed age-appropriate toys and furnishings throughout the CCC. LPA observed a fire suppression system, smoke, and carbon monoxide detectors throughout the CCC, one of which was tested at 9:47AM and found to be operational. Restrooms and changing stations for children in care were found to be safe, sanitary, and in operating condition. In each of the classrooms, LPA observed sharps, disinfectants, and other hazardous items stored in areas inaccessible to children in care.

The CCC provides snacks as needed for children in care. LPA observed the menu posted prominently in the CCC. LPA notes that filtered water is shipped to the CCC for children in care.

(Cont. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: DUAL IMMERSION ACADEMY OF CALIFORNIA
FACILITY NUMBER: 566217141
VISIT DATE: 03/02/2026
NARRATIVE
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CCCs constructed before January 1, 2010, are required to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA notes there is a Water Use Attestation on file.

The CCC uses an outdoor play area for children in care, which is fully enclosed & partitioned with fencing. LPA notes the entry/exit points are secured. LPA observed age-appropriate toys/play equipment in the play area. The toys/play equipment are free of sharp, loose or pointed objects and there is adequate cushioning to absorb falls, by way rubber cushioning tiles. LPA notes that latched cabinets and a latched storage closet inside the CCC are used to store hazardous & surplus items. There is an abundance of shade in the outdoor area provided by a canopy structure. No bodies of water were observed on site.

A sampling of five (5) staff and six (6) children’s records were reviewed. At 10:22AM PST, during record review and upon interviewing Director, LPA determined that the LIC 501 - Personnel Record was not on file for Staff #01 (S1) and S4. LPA observed on-site correction as S1 & S4 completed the form during the inspection. Director understands the requirement to maintain current & complete personnel records. A Technical Violation (TV) was issued. The staff records reviewed were found otherwise to be current & complete. At 11:30AM PST, during record review and upon interviewing Director, LPA determined that the LIC 702 - Health History, was not on file for Child # 03 (C3), C4, C5, & C6. Director understands the requirement to maintain current & complete children's records. The children’s records reviewed were found otherwise to be current and complete. LPA reviewed the facility's fire/emergency drill log and notes the most recent drill was conducted on 1/06/2026. Director informed LPA no firearms/weapons or ammunition are stored on the premises.

This facility does not currently provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

(Cont. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026
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: DUAL IMMERSION ACADEMY OF CALIFORNIA
FACILITY NUMBER: 566217141
VISIT DATE: 03/02/2026
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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 Director 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.

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.

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.

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.

During today’s inspection, one (1) Type B deficiency was issued under Title 22 of the California Code of Regulations & Health and Safety Codes. Appeal rights were provided & explained to Director. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Georgina Fernandez.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2026 01:18 PM - It Cannot Be Edited


Created By: Seena Parsapour On 03/02/2026 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: DUAL IMMERSION ACADEMY OF CALIFORNIA
FACILITY NUMBER: 566217141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, Director did not comply with the section cited above in that the LIC 702 - Health History, was not on file for Child # 03 (C3), C4, C5, & C6, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2026
Plan of Correction
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Director shall submit to the Department (seena.parsapour@dss.ca.gov) photographs or copies of the completed LIC 702 for C3, C4, C5, & C6, as well as a written statement explaining how they plan on ensuring compliance with this requirement moving forward, no later than Thursday, March 12th, 2026.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Seena Parsapour
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2026


LIC809 (FAS) - (06/04)
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