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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408020
Report Date: 05/23/2022
Date Signed: 05/23/2022 02:52:13 PM


Document Has Been Signed on 05/23/2022 02:52 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:VENTANA SCHOOLFACILITY NUMBER:
434408020
ADMINISTRATOR:AMY BAKERFACILITY TYPE:
850
ADDRESS:1040 BORDER ROADTELEPHONE:
(650) 948-2121
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:80CENSUS: 51DATE:
05/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Shobha SolomonTIME COMPLETED:
03:00 PM
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On 05/23/2022 at 9:45am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced Case Management Visit for the purpose of clearing Plan of Corrections from previous annual inspection on 04/22/22 and to verify director and teachers' qualifications. Additionally, COVID-19 follow up was conducted for three previously reported cases at the facility. LPA Uribe met with Site Director, Shobha Solomon, and also present during today's visit is 9 staff and 51 children.

LPA Uribe reviewed student, staff, & director files at 10:30am to clear plan of corrections. During this time, LPA Uribe also reviewed transcripts, resumes, & other certifications to evaluate teachers' and director's qualifications. All student files requiring plan of corrections have been corrected and cleared.

Two Type B Deficiencies were cited on 04/22/22 with a due date of 05/20/22 for a plan of correction. Neither deficiencies will be cleared today due to some staff members still needing to provide one of the following: 1) TB Clearance, 2) Health Screening Report (LIC 503) & TB Clearance, 3) Proof of MMR (Measles) Immunization. LPA Uribe is allowing the remainder of this week for each staff member to provide the necessary documents in order to clear the deficiencies. Proof of correction will be emailed to LPA Uribe at christina.uribe@dss.ca.gov no later than this Friday, 05/27/22 by 6pm. If these proof of corrections are not provided by the due date listed, an issuance of an additional violation will be cited for failure to correct.

LPA Uribe obtained the required forms for the director packet but was unable to qualify director due to incomplete qualifications. Director is currently enrolled and attending the required Administration/Staff Relations course and all other requirements are met. Additionally, LPA Uribe was able to review 11 staff files and was able to verify teacher qualifications for 8 staff members during today's visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Shobha Solomon.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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