566214919-10-14-2022-17-CC-RCHZ-CK7U3E-20221014151326

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566214919
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:13:40 PM

Document Has Been Signed on 10/14/2022 03:13 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:	VUSD - PACIFIC HIGH JUMPSTART STATE PRESCHOOL		FACILITY NUMBER:	566214919
ADMINISTRATOR:	LORETTA GALAVIZ		FACILITY TYPE:	850
ADDRESS:	501 COLLEGE DRIVE		TELEPHONE:	(805) 641-5000
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 28	CENSUS: 0	DATE:	10/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Amanda Vogl		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	On October 14, 2022 at 1:21 PM, Licensing Program Analyst (LPA) Rona Chavez conducted an unannounced Annual/Random inspection. LPA met with Site Supervisor Amanda Vogl and advised her the purpose of the inspection. Supervisor provided LPA a tour of the facility inside and out. There were 0 children in care at the time of the inspection. Center uses 2 classrooms and is on the campus of Pacific High School. Center hours are 8:15am-11:15am for the preschool and team meetins and IEPs for the afternoon session. LPA observed required licensing documents mounted on the wall at the entrance of the facility. LPAs observed a facility menu posted on the wall. The center provides breakfast and the food is provided by the school cafeteria. The facility has enough restrooms available for the children in care. LPAs did not observe any hazards/toxins items accessible to children. Each of the classrooms have age appropriate toys and furniture readily accessible for children in care. LPA observed a functioning carbon monoxide/smoke detector, first aid kit, and fire alarm. The outdoor playground has an ample amount of space for children to play. LPA observed the playground has age appropriate toys and structures available for children to use. The playground has ample amount of shade available. The facility has water available for children inside and out. Center uses hand written sign-in and sign-out logs. A sampling of children records were reviewed and found complete. Center currently provides Incidental Medical Services (IMS) and the medication is locked in the health office with the school nurse. Teacher files were reviewed and have required qualifications. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 09/14/2023. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Cont on 809-C

Ana Tolentino
Rona Chavez
	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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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Document Has Been Signed on 10/14/2022 03:13 PM - It Cannot Be Edited

Created By: Rona Chavez On 10/14/2022 at 02:42 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VUSD - PACIFIC HIGH JUMPSTART STATE PRESCHOOL	FACILITY NUMBER: 566214919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited and staff did not have a current First Aid/CPR on file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/21/2022
	Plan of Correction
1 2 3 4	Site Supervisor will provide proof of compleation and provide LPA certificate by 11/21/2022 by email. rona.chavez@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ana Tolentino

LICENSING EVALUATOR NAME:

Rona Chavez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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 - PACIFIC HIGH JUMPSTART STATE PRESCHOOL	FACILITY NUMBER: 566214919
	VISIT DATE: 10/14/2022

NARRATIVE

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Teachers present do not have current Pediatric First Aid/CPR certificates. Site Supervisor did an online course during COVID-19 pandemic and was aware that it was the wrong course. POC was discussed and will reach out to school district manager for scheduling.

One type B violation was cited during today's inspection. See attached 809-D

Site Supervisor 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.

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

SUPERVISOR'S NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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 - PACIFIC HIGH JUMPSTART STATE PRESCHOOL	FACILITY NUMBER: 566214919
	VISIT DATE: 10/14/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

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.

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 Amanda Vogl.

SUPERVISOR'S NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC809 (FAS) - (06/04)

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