561701236-7-13-2021-17-CC-JMHL-C4VQU8-20210713122819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 561701236
Report Date: 07/13/2021
Date Signed: 07/13/2021 12:28:32 PM

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:	FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.		FACILITY NUMBER:	561701236
ADMINISTRATOR:	AUTUMN MCGUIRE		FACILITY TYPE:	850
ADDRESS:	1338 EAST SANTA CLARA STREET		TELEPHONE:	(805) 653-5304
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	61	CENSUS: 27	DATE:	07/13/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Autumn McGuire		TIME COMPLETED:	12:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jill Laxo conducted an unannounced Case Management inspection to the center to discuss two self reported incidents. LPA met with the Director Autumn McGuire and explained the purpose of the visit and together toured the facility inside and out. There were a total of 27 children, under the care and supervision of six staff. On April 1, 2021, Autumn McGuire reported to the Department as required two incidents that occurred on March 31, 2021. The first incident occurred at approximately 4:15 p.m. during outside play. A truck hit the corner of the building, and came to a stop inside classroom 107 (Monkey Room) Ventura Police officers were on site. No children were in the classroom at the time of the incident. There is structural damage in the building, and a water line was broken and since repaired. There were no injuries. The City of Ventura has placed the room off limits until the repairs have been completed. LPA observed the classroom with boards and plastic over the wall that was damaged. The classroom 107 is off limits and also classroom 106. The structural damage will be repaired by contractors and estimated reopening by September 2021. Children in the Toddler Component were relocated to classroom 103. The second incident occurred on March 31, 2021, at 9:15 a.m. in the Monkey classroom. Autumn McGuire self reported that teacher #1 (T1) left a spray bottle of bleach water on the table in classroom 107 (Monkey room). Teacher #2 (T2) walked by the classroom and observed C1 pick up the spray bottle. Continued on 809C.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.	FACILITY NUMBER: 561701236
	VISIT DATE: 07/13/2021

NARRATIVE

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T2 alerted T1, and the bottle was removed from C1, and secured in a locked cabinet. At 10:45 a.m. T1 escorted C#1 to the directors office due to C1's red and irritated eyes. T2 described in detail the incident which occurred in classroom 107. Director viewed the video of the incident and determined C1 rubbed their eyes while holding the spray bottle of bleach water. T1 was placed on administrative leave until investigation was completed. T1 is no longer employed at facility. LPA was provided the video of the incident, records, and T1's interview with director and Pastor.

Pursuant to Title 22 of the California Code of Regulations, the following Type A deficiency was cited: 101238 (g). (refer to LIC 809-D). Today's reports were reviewed and issued.

Director was provided with a copy of appeal rights. This report must be posted for 30 days. Licensee is to provide a copy of this report to each parent/legal guardian of every child for the next 12 months. Every parent/guardian must sign a LIC 9224 "Acknowledgment of Licensing Reports" and place a copy of this document in each child's file for the next 12 months.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.	FACILITY NUMBER: 561701236
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/16/2021 Section Cited	1 2 3 4 5 6 7	101238 (g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on Observation, interviews, and record review cleaning solutions, and other items that could pose a danger were accessible to children in care. This poses an immediate risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

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