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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214141
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:09:16 PM

Document Has Been Signed on 06/16/2023 02:09 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
CENTRAL COAST-CHILD, 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: 89DATE:
06/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Catherine RutledgeTIME COMPLETED:
02:30 PM
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On 06/16/23, Licensing Program Analysts (LPAs) Giovani Gonzalez and German Negrete made an unannounced visit for the purpose of conducting a Case Management inspection. LPA met with Director Catherine Rutledge to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office by phone on 06/14/2023. LPAs toured the area where the incident occurred and interviewed Director and Staff 1 (S1). At the time of inspection there were 89 children along with 26 staff.

On 06/13/23 an incident occurred at the center.Director reported Child 1 tripped, fell and bumped head on a wooden doll house. C1 sustained a large bump on their head. C1 was picked up from center and was taken to a medical facility by parent.

LPAs interviewed Director Catherine Rutledge. Director stated that C1 was running around a table when they were getting ready to go outside. Director stated C1 tripped on either the table or chair and hit her head on the wooden doll house. Director stated that C1 has not returned since the incident. Director attempted to contact parent to confirm C1 was taken to the doctor but was unable to reach them.
LPAs interviewed S1 regarding the incident. S1 stated that it occurred during a indoor to outdoor transition. S1 stated that C1 was running around the class and table. S1 stated that C1 tripped on her own foot and bumped her head on the wooden play house.

Given that there were no tripping hazards observed and the incident was observed by staff who took appropriate action by provided an ice pack for the child, calling the child's parents and reporting incident to CCLD, no deficiencies are being issued as a result of this incident.

Notice of site visit was given, and should remain posted for a minimum of 30 days.

Exit interview conducted and report reviewed with Director Catherine Rutledge.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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