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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214141
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:29:57 PM

Document Has Been Signed on 08/25/2021 12:29 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: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: 68DATE:
08/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anna IzaguirreTIME COMPLETED:
09:40 AM
NARRATIVE
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On 8-25-2021 at 9:00 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 68 children in care at the time of the inspection.

On 7/21//2021, Director self reported that on July 21, 2021 at approximately 11:15 AM the teachers were transitioning the children from outdoor play back into the classroom. The teachers did a count of children outside accurately but as they were entering into the classroom C#1 hid from the staff. About two minutes after entering the room staff heard a child crying outdoors. S#2 brought the child into the classroom. Director stated staff training on following the name to face recognition record documenting children who are present and children who leave the classroom will be done. In addition, an email will go out reminding staff of the reporting policy that the facility has in place and staff will be placed on progressive discipline for not following the policy in place.

Today, LPA inspected the area and observed where the incident took place. The Director reported the incident and submitted the incident report to the Department as required. LPA advised the director that the incident was an absence of supervision.

The following CCR, Title 22, Division 12 regulation was cited 101229(a)(1) Responsibility for Providing Care and 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: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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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Document Has Been Signed on 08/25/2021 12:29 PM - It Cannot Be Edited


Created By: Austin Rios On 08/25/2021 at 08:17 AM
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: EASTER SEALS VENTURA CDC
FACILITY NUMBER: 566214141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2021
Section Cited
CCR
101229(a)(1)

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101229(a)(1): Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ...to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher ... visual observation.
This requirement is not met as evidenced by:
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Director will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations and avoid any children left unattended by 9/8/2021.
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Based on LPA's observation during the inspection tour and director self-reporting the incident, Child #1 was left unsupervised outside the classroom. This is an immediate risk to the health and safety of the children in the facility.
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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.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Austin Rios
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021


LIC809 (FAS) - (06/04)
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