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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214141
Report Date: 08/26/2022
Date Signed: 08/26/2022 11:49:23 AM

Document Has Been Signed on 08/26/2022 11:49 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: 122CENSUS: 42DATE:
08/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Catherine RutledgeTIME COMPLETED:
12:05 PM
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On 8/26//2022 at 11:05 AM, Licensing Program Analyst (LPA) Austin Rios and conducted an unannounced Case Management inspection. LPA met with facility Director Catherine Rutledge and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 42 children in care at the time of the inspection.

On 8/24/2022 facility called in to report an incident report that happened on 8/23/2022. RP states that Child got cut on the back of their head from a screw that was protruding from a swing. The screw came out of place from where it normally would be covered due to wear and tear. The staff notified parents right away and the parents took the child to the doctor. The child received just a butterfly bandage on the cut. No stitches or glue was required on the injury.

Today, LPA inspected the area and observed where the incident took place at. LPA observed the swing was already taken out of the playground immediately the same day after the incident. There was 3 staff outside supervising when incident happened.. Staff took proper action after incident occurred and cleaned cut with soap and water, comforted child, and called parents.

LPA discussed with director to inspect day care equipment daily to make sure no screws are hanging out and that equipment is in good shape and safe. A technical violation LIC9102 was issued to facility for safety of day care equipment. A notice of site visit was given.

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: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2022
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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