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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215252
Report Date: 05/08/2019
Date Signed: 05/08/2019 02:48:51 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 CHILDREN'S LEARNING CENTERFACILITY NUMBER:
566215252
ADMINISTRATOR:VIKTORIIA SHEVKUNOVAFACILITY TYPE:
850
ADDRESS:1110 PETIT AVE.TELEPHONE:
(805) 672-0300
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:128CENSUS: 78DATE:
05/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Viktoriia ShevkunovaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Michael Avila made an unannounced visit for the purpose of conducting a Case Management inspection. On 5/3/2019, Licensee self reported an incident of a child sustaining an injury while in care. LPA Avila met with Licensee Viktoria Shevkunova and discussed the nature and purpose of the visit.

On 5/2/19 at/or around 10am, a child tripped and fell striking his head on a metal fence post. The child sustained a large bump on his head and Licensee immediately called the child's parents who arrived shortly thereafter to take their child to seek medical attention. The child received medical care and was released to the parents that same day. The child is back in care at the facility.

LPA reviewed a video recording of the incident which clearly recorded the child tripped over his shoelace that became untied as he was running across the playground causing him fall and strike his head on a metal fence post.

Given Licensee's account of the incident when reporting it to the Department was the same as viewed by video recording of the incident and given Licensee took immediate action in rendering first-aid and contacting the parents of the child, LPA deemed Licensee's action as appropriate.

No deficiencies were issued for this incident.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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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