566203831-5-8-2019-17-CC-JMHL-BBYUE7-20190508153041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566203831
Report Date: 05/08/2019
Date Signed: 05/08/2019 03:30:48 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 - ELMHURST ELEMENTARY		FACILITY NUMBER:	566203831
ADMINISTRATOR:	JULIE O'BRIEN		FACILITY TYPE:	840
ADDRESS:	5080 ELMHURST ST.		TELEPHONE:	(805) 256-2474
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	48	CENSUS: 6	DATE:	05/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kimberly Scott		TIME COMPLETED:	03:35 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 Analysts, (LPAs) Jill Laxo and Francisco Pedroza conducted an unannounced annual/random inspection and met with Site Supervisor Kimberly Scott and Julie O'Brien Youth Programs Director. The center was toured inside. The school age program has one room, with two children bathrooms. Bathrooms were in safe and sanitary condition and free of hazards. LPAs observed two teachers supervising six children. The program operates after school from 12:30 p.m. until 6:00 p.m. Facility provides an afternoon snack to the children. LPAs reviewed posted monthly menu. Kitchen, food preparation, storage area are kept clean, free of litter. Food is properly labeled and dated. The facility is adequately equipped with age and size appropriate furniture and equipment is in good condition. Disinfectants and cleaning supplies are stored in locked cabinet in the supply room, not accessible to children. The playground utilized by the program is on school campus and fully enclosed. Drinking water is readily available inside and outside. There were no bodies of water. Director stated there were no guns nor ammunition in the center. Center has written sing-in/sign-out sheets. A sampling of children and staff records were reviewed. Continued on 809C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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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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 - ELMHURST ELEMENTARY	FACILITY NUMBER: 566203831
	VISIT DATE: 05/08/2019

NARRATIVE

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LPAs reviewed personnel records which contained documents for education, Mandated Reporter AB 1207, CPR/First Aid expires 03/25/2021, and criminal background clearance. Children records were reviewed and current.

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

Effects of Lead Exposure brochure was provided.

There were no deficiencies cited today.

The LIC 9213 (Notice of Site Visit) was posted during the visit.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

LIC809 (FAS) - (06/04)

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