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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703051
Report Date: 11/28/2022
Date Signed: 11/28/2022 02:36:35 PM


Document Has Been Signed on 11/28/2022 02:36 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, 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: 13DATE:
11/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Margarita "Rita" OrtizTIME COMPLETED:
02:50 PM
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On November 28, 2022 at 1:16 PM, Licensing Program Analyst (LPA) Susana Martinez and Licensing Program Manager (LPM) George Mingle conducted an unannounced Case Management- Incident inspection. LPA and LPM met with lead teacher Margarita "Rita" Ortiz and advised the reason for the inspection. At the time of the inspection there were 13 children present and 5 staff members. LPA, LPM and Rita toured the facility inside and outside. The center operates Monday- Friday from 8 am- 2pm.

On 9/30/22 the center submitted an unusual incident report involving a child in care who fell back and hit the back of the head while in the outdoor play area while practising with a walker. LPA reviewed the child's records - Meeting on 3/30/2021 with Ventura Unified School District in regards to child's assessment. Assessment states the child needs a walker with close supervision. The center also has a 504 plan that was signed on 6/28/2022 which did not require the child to use a walker for practice.

LPA reviewed the child's files and determined the center has all documentation required regarding child's 504 plan. Child did require a one on one supervision at one point, but due to developmental plan reviews, outgrew that requirement. Rita states that on the day of the incident there were 3 staff members present along with 10 children present.

Based on record review and interviews it was determined that this incident was an accident. A technical Advisory was was given on today's visit.
There were no deficiencies cited during this inspection.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022
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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