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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566214141
Report Date: 09/14/2023
Date Signed: 09/14/2023 05:15:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2023 and conducted by Evaluator Laura Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20230717133128
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:122CENSUS: 26DATE:
09/14/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Heather GuerreroTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not prevent day care child from sustaining injuries while in care
Staff hit day care child
INVESTIGATION FINDINGS:
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On September 14, 2023 at 02:15 PM Licensing Program Analyst (LPA) Laura Villanueva made an unannounced inspection to conclude the investigation for the above allegations. LPA met with Area Director, Heather Guerrero and explained the purpose of the visit. LPA conducted a tour of the facility with Julie Perez, Family Service Worker inside and outside. LPA observed a total of 26 children under the care and supervision of 7 staff.

On 6/16/2023, LPA Giovani Gonzalez conducted a case Managment-Incident visit. LPA Gonzalez interviewed director and S1. Center conducted an internal investigation on S1. Allegations of staff hitting children were found to be unsubstantiated. LPA Villanueva conducted parent interviews, staff interviews, and record review. Parents interviewed are happy with the care and supervision their child receives. The incident occurred when C1 and another child were reaching for the same book, when the book hit C1 on her left eye. The injury to C1's face did occur and a written Special Injury report and an ouch report were completed. The incident of C1 sustaining injuries was not reported to the Department because no medical care was needed.
CONTINUED ON LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2023 and conducted by Evaluator Laura Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20230717133128

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:122CENSUS: 26DATE:
09/14/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Heather GuerreroTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not report injuries to child's authorized representative
INVESTIGATION FINDINGS:
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On September 14, 2023 at 02:15 PM Licensing Program Analyst (LPA) Laura Villanueva made an unannounced inspection to conclude the investigation for the above allegations. LPA met with Area Director, Heather Guerrero and explained the purpose of the visit. LPA conducted a tour of the facility with Julie Perez, Family Service Worker inside and outside. LPA observed a total of 26 children under the care and supervision of 7 staff.

LPA conducted parent interviews, staff interviews, and record review. LPA reviewed child file and found a completed special injury report (SIR) and an ouch report. The report stated that S4 called and reported the occurrance to the parent. The incident and ouch reports were not signed by the parent. Area Director explained that it is policy to give a parent a copy of the special incident report and an ouch report. The parent does not have to sign to acknowledge receipt of the SIR. An ouch report is completed by the staff and given to the parent to sign. A white copy is given to the parent and a yellow copy is filed in the child file. When an
CONTINUED ON LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20230717133128
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CDC
FACILITY NUMBER: 566214141
VISIT DATE: 09/14/2023
NARRATIVE
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SIR is completed, the parent does not have to sign an acklowdgement of receipt. There is no evidence that the parent was informed of C1's injury. “Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), A technical advisory was given.


THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

Exit interview conducted with Area Director, Heather Guerrero. A copy of the Appeal Rights (LIC 9058 FAS 01/16) was given and explained. Area Manager's signature on this form acknowledges receipt of these rights. A notice of site visit was given.



SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 17-CC-20230717133128
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CDC
FACILITY NUMBER: 566214141
VISIT DATE: 09/14/2023
NARRATIVE
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Although the allegations may have happened or invalid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited for today. Exit interview conducted and report was reviewed with the Area Director, Heather Guerrero and a copy was provided.

The Notice of SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY. THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4