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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215252
Report Date: 08/23/2024
Date Signed: 08/23/2024 07:18:55 PM


Document Has Been Signed on 08/23/2024 07:18 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
SANTA BARBARA CC RO, 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: 59DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Valeria Marquez TIME COMPLETED:
03:19 PM
NARRATIVE
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On 08/23/2024 a Case Management Inspection was conducted by LPA German Negrete who met with Preschool Director Valeria Marquez(director). LPA advised the purpose of today's inspection was to conduct a case management incident inspection and to complete a investigation. The investigation was initiated due to a incident which was reported to the Department on 05/22/2024. Today LPA conducted a tour of the facility inside and out with director. LPA observed 59 children being supervised by 5 staff.

Director Viktoriia Shevkunova stated the following: On 5/22/2024 at 2:32 PM, Child#1 (C#1,5 years 5 months) attempted to jump off the small play structure(play-structure#1), C#1 lost coordination/balance and C#1 landed on the right arm. The lead teacher, S#1 approached C#1 after observing C#1 crying. The director called the parent of C#1, Parent (an employee) to come and comfort C#1. Also director was able to show camera footage of the incident to Parent. On 8/12/2024 LPA coducted a parent interview which confirmed parent was able to observe the camera footage of the incident.

The investigation included, staff interview, Director interview, and parent of C#1 interview. Also LPA reviewed facility files/records and the manufacturer instructions for play structure#1.

LPA discovered during staff interviews , lead teacher(S#1) was present on the play yard when the incident occurred(5/22/2024). S#1 stated, how S#1 did not observe the incident when the child fell of the play structure#1. However S#1 approached C#1 when S#1 observed C#1 crying. S#2 ran across form the preschool yard, and approached C#1 to comfort C#1. Staff brought ice to be placed on C#1. From staff interviews, LPA confirmed the ratio at the time of the incident was 12 children being supervised by one Lead Teacher.

Continued on LIC809-C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German NegreteTELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: VENTURA CHILDREN'S LEARNING CENTER
FACILITY NUMBER: 566215252
VISIT DATE: 08/23/2024
NARRATIVE
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During the course of the investigation LPA also received manufacturer instructions(play-structure#1) from Director. LPA read/reviewed manufacturer instructions for play structure#1 and confirmed the age range for play structure#1 is designed for 1.5 year old infants to 4 years old children.

LPA also interviewed parent of child#1. Parent stated, parent was inside the facility working as a employed staff when the incident occurred. Parent was notified through the radio that C#1 was crying. Once parent approached C#1 and observed C#1 was crying. And Child #1 stated , C#1 was in pain due to C#1's right arm hurting. Parent called their partner in order for C#1 to be transported to the Emergency Department at the Ventura County Medical Center. At the Emergency Department parent confirmed C#1 did receive a elbow fracture (right arm).

Due to C#1 playing with a play structure (play-structure#1) not suitable for C#1's age group LPA has determined the facility was not in compliance with Title 22 California Code of Regulations and a Type B deficiency will be cited (See LIC809-D-page)

Exit Interviewed conducted with Director. A notice of site visit was provided.



Appeal Rights were provided.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German NegreteTELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 08/23/2024 07:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: VENTURA CHILDREN'S LEARNING CENTER
FACILITY NUMBER: 566215252

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2024
Section Cited
CCR
101239(m)

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(m) All play equipment and materials used by children shall be age-appropriate.

Based on LPA's observations and file/record review the facility was not in complicane with the aforementioned regulation...
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The facility will email LPA Negrete and provide a signed statement from director Viktoria Shevkunova, and preschool director Valeria Marquez stating they understand Title 22 california code of regulations section 101239(m).
German.Negrete@dss.ca.gov
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The facility allowed a 5 year old child to play/interact with play structure#1. The aforemtioned play structure#1 is intended for children 1 to 4 years old. Therefor the facility did not follow Title 22 California Code of Regulations.
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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 TolentinoTELEPHONE: (805) 218-0429
LICENSING EVALUATOR NAME: German NegreteTELEPHONE: 805-315-8362
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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