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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208287
Report Date: 10/09/2019
Date Signed: 10/09/2019 04:02:56 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:VUSD - PORTOLA JUMPSTART STATE PRESCHOOL PROGRAMFACILITY NUMBER:
566208287
ADMINISTRATOR:KATE HENGGELERFACILITY TYPE:
850
ADDRESS:6700 EAGLE ST.TELEPHONE:
(805) 289-1734
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:24CENSUS: 20DATE:
10/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Neomi JimenezTIME COMPLETED:
04:15 PM
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Licensing Program Analyst, (LPA) Jill Laxo conducted an unannounced annual inspection and met with Neomi Jimenez and together toured the preschool inside and out. There were four teachers supervising 20 children. Bathrooms were in safe and sanitary condition and free of hazards. The one classroom was adequately equipped with age and size appropriate furniture and equipment was in good condition. Menus were posted for breakfast and lunch and food is provided by the school cafeteria. Disinfectants and cleaning supplies were not accessible 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 in the center.

Sign in/out sheets were reviewed and contained full signatures. Personnel records were viewed and contained documents for education, AB 1207, CPR/First Aid expires 12/6/2020, and criminal background clearance. Children records contained authorized representative contact information, Emergency information, immunization, and Notification of Parents Rights.

First aid box is stored in upper cabinet and labeled. All medication is stored in a locked bag in a cabinet above 5 feet. The Incidental medical service plan is posted and readily available for staff.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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: VUSD - PORTOLA JUMPSTART STATE PRESCHOOL PROGRAM
FACILITY NUMBER: 566208287
VISIT DATE: 10/09/2019
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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

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: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2