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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213485
Report Date: 05/09/2019
Date Signed: 05/09/2019 11:00:29 AM

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:CDI - SHERIDAN WAY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
566213485
ADMINISTRATOR:RACHEL CHAMPAGNEFACILITY TYPE:
850
ADDRESS:573 SHERIDAN WAYTELEPHONE:
(805) 643-7612
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:24CENSUS: 20DATE:
05/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jazmin LopezTIME COMPLETED:
10:30 AM
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Licensing Program Analysts, (LPAs) Jill Laxo and Francisco Pedroza conducted an unannounced annual/random inspection and met with Site Supervisor Jazmin Lopez. The facility is located on the Sheridan school campus. The center was toured inside and out. The preschool program has one room, with one designated bathroom for children. The bathroom was in safe and sanitary condition and free of hazards.

LPAs observed three teachers supervising twenty children. The program operates from 6:30 a.m. until 6:00 p.m. Facility provides breakfast, lunch and snack to children. LPAs reviewed posted monthly menu. Kitchen, food preparation, storage areas were clean, and free of litter. Food was properly labeled and dated. The facility was adequately equipped with age and size appropriate furniture and equipment was in good condition. Floors were clean and safe. Disinfectants and cleaning supplies were stored in locked cabinets in the kitchen and bathroom, not accessible to children. The playground is fenced and only used by the children in care. Water coolers were inside and cups and water pitchers were outside for the children. Medication was stored in a labeled locked box inaccessible to children, expiration date 11/30/2019. There were no bodies of water. Director stated there were no guns or ammunition stored at the center. Continued on 809C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: CDI - SHERIDAN WAY CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 566213485
VISIT DATE: 05/09/2019
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Center had written sing-in/sign-out sheets with full signatures and a communication board with all required documents posted. LPAs reviewed personnel records which contained documents for education, current Mandated Reporter AB 1207, CPR/First Aid expires 03/27/2020, and criminal background clearance. Children records were reviewed and current with proof of immunization, list of each child's authorized representative, and signed parent handbook agreement form.

This facility provides Incidental Medical Services – IMS. LPAs 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

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 MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
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