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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214141
Report Date: 07/08/2021
Date Signed: 07/08/2021 11:23:49 AM

Document Has Been Signed on 07/08/2021 11:23 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:EASTER SEALS VENTURA CDCFACILITY NUMBER:
566214141
ADMINISTRATOR:REBECCA KLAMSERFACILITY TYPE:
850
ADDRESS:10730 HENDERSON ROADTELEPHONE:
(805) 647-1141
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 122TOTAL ENROLLED CHILDREN: 0CENSUS: 64DATE:
07/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Anna IzaguirreTIME COMPLETED:
11:32 AM
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On 7-8-2021 at 10:13 AM , Licensing Program Analyst (LPA) Austin Rios conducted an unannounced Case Management inspection. LPA met with facility Director Anna Izaguirre and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 64 children in care at the time of the inspection.

On 6/8/21, Director self reported, Staff#1 had left Child #1, #2 and #3 unattended in classroom to step into adjoining classroom to ask another teacher a question regarding training. Staff#1 was able to hear children, however, staff only had partial view of the children. Staff immediately returned back to the classroom within 30 seconds. Staff informed Director of the incident immediately. Teacher was spoken to about the incident and was informed of proper care and supervision. Director is planning training for expectations due to the incident. Today, LPA inspected the classrooms and observed where the incident took place. The Director reported the incident and submitted the incident report to the Department as required.

A technical violation LIC9102 was issued to licensee for absence of supervision.



Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2021
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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