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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213155
Report Date: 11/17/2021
Date Signed: 11/17/2021 02:28:18 PM

Document Has Been Signed on 11/17/2021 02:28 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:PACIFIC CAMPS VENTURAFACILITY NUMBER:
566213155
ADMINISTRATOR:ANASTACIA PEREZFACILITY TYPE:
840
ADDRESS:426 S. MILLS RD.TELEPHONE:
(805) 654-0686
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 32DATE:
11/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anastacia PerezTIME COMPLETED:
02:43 PM
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On November 17, 2021 at 1:35 pm, Licensing Program Analysts (LPAs) Francisco Pedroza and Dean Thompson conducted an unannounced Annual/Random inspection. LPAs met with facility site supervisor Anastacia Perez and advised the purpose of the inspection. LPAs toured the facility inside and out. The center operates from 11:00 AM to 6:00 PM, Monday thru Friday. There were 32 children in care at the time of the inspection.

Licensing required notices were posted prominently on the wall in the facility office. The facility uses two rooms for children in care and an outdoor recreation area. Each classroom has age appropriate toys and equipment. LPA did not observe any toxins/hazardous items accessible to children. LPA observed a posted snack menu that children have an opportunity to purchase from the center. The outdoor recreation area has sufficient amount of space available for child to enjoy activities. There is drinking water available both inside and outside for the children. Currently the facility does have one child requiring incidental medical services (IMS). LPAs observed where the medication is stored and secured preventing children from having access.

LPAs were not able to review staff and children records at the time of the inspection due to the site supervisor being part of the staff count. A staff member was called out sick. LPAs will have to review records at a later date. Last emergency drill was conducted on 10/21/21. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis. LPAs observed staff and children wearing face masks.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2021
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: PACIFIC CAMPS VENTURA
FACILITY NUMBER: 566213155
VISIT DATE: 11/17/2021
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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

No deficiencies were cited during today's inspection.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
LIC809 (FAS) - (06/04)
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