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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708173
Report Date: 03/04/2020
Date Signed: 03/04/2020 02:13:47 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:VENTURA BRANCH - POINSETTIA ELEMENTARYFACILITY NUMBER:
561708173
ADMINISTRATOR:JULIE O'BRIENFACILITY TYPE:
840
ADDRESS:350 N. VICTORIA AVE.TELEPHONE:
(805) 654-0620
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:48CENSUS: 18DATE:
03/04/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Amanda PinedoTIME COMPLETED:
02:45 PM
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Licensing Program Analyst, (LPA) Jill Laxo conducted an unannounced annual inspection at Poinsettia YMCA and met with Amanda Pinedo. The center was toured inside and out. There were two teachers supervising 18 children. Bathrooms were in safe and sanitary condition and free of hazards. Classroom was adequately equipped with age and size appropriate furniture and equipment was in good condition. Menus are posted for afternoon snack and school breakfast and lunch. There are no medications being administered at this time. Disinfectants and cleaning supplies are locked and stored in an off limits room inaccessible to children in care. Drinking water is readily available indoors and children are encouraged to use their water bottles for outdoor play. The school is enclosed and the program utilizes a grass area for lunch time and outdoor play. The school equipment is in safe condition including cushioning material and was free of hazards. There are no bodies of water. Site Supervisor stated there are no guns nor ammunition on the premises.

Sign in/out sheets were reviewed and found complete. Personnel records were viewed and contained documents for education, AB 1207, health screening, CPR/First Aid expires 03/19/2021, and criminal background clearance. Eleven children records were reviewed and contained authorized representative contact information and individual medical assessment.

Continued on 809-C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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: VENTURA BRANCH - POINSETTIA ELEMENTARY
FACILITY NUMBER: 561708173
VISIT DATE: 03/04/2020
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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


Lead Exposure brochures were provided.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
LIC809 (FAS) - (06/04)
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