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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703051
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:20:23 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:CDR - BENITA WALLICK HEAD STARTFACILITY NUMBER:
561703051
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2717 NORTH VENTURA AVENUETELEPHONE:
(805) 648-3083
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:40CENSUS: 0DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria JohnsonTIME COMPLETED:
03:05 PM
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An annual review was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson who met with Site Supervisor Maria Johnson. The center was toured inside and outside. The preschool operates Monday - Friday, 8:00 AM - 2:00 PM. LPAs were advised there was no medication being administered at this time. The classrooms were observed to be clean and orderly. The appropriate documents including the menu was posted for review. The handouts “A Child Care Provider’s Guide to Safe Sleep, Safe Sleep in Child Care, and Effects of Lead Exposure were reviewed. The restrooms were observed to be clean. The outside playground equipment was observed to be well maintained and age appropriate. A random review was conducted of children's records. Staff records are maintained at the main office. LPA reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPAs discussed the requirement of AB1207 Child Abuse Mandated Reporter Training for staff. LPAs reviewed current CPR and First Aid for three (3) staff.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies cited. The Notice of Site Visit was posted at the visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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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