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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207389
Report Date: 03/13/2020
Date Signed: 03/13/2020 03:13:50 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 - LOMA VISTA ELEMENTARYFACILITY NUMBER:
566207389
ADMINISTRATOR:JULIE O'BRIENFACILITY TYPE:
840
ADDRESS:300 LYNN DR.TELEPHONE:
(805) 256-2475
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:55CENSUS: 19DATE:
03/13/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Julie O'BrienTIME COMPLETED:
03:30 PM
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On 03/13/2020 at 1:40 p.m. Licensing Program Analysts, (LPAs) Jill Laxo and Austin Rios conducted an unannounced annual inspection at Loma Vista YMCA and met with Julie O'Brien. The facility conducts the after school program in a small classroom and multipurpose room. There were two teachers supervising 19 children. Children bathrooms were in safe and sanitary condition and free of hazards. Adult restrooms are located in the teachers lounge. Afternoon Snack is prepared and menu is posted. All storage containers for solid waste have tight fitting covers and are in good repair. Disinfectants and cleaning supplies are located in a locked cabinet and inaccessible to children. Drinking water was readily available both indoors and out. Playground was enclosed with equipment in safe condition including cushioning material and was free of hazards. There were no bodies of water. Director 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/Pediatric First Aid expires 04/25/2021, and criminal background clearance. Four children records were reviewed and contained authorized representative contact information and individual medical assessment. Emergency drill was last performed on October 15, 2019.

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: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
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 - LOMA VISTA ELEMENTARY
FACILITY NUMBER: 566207389
VISIT DATE: 03/13/2020
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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: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
LIC809 (FAS) - (06/04)
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