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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801913
Report Date: 02/22/2023
Date Signed: 02/22/2023 02:29:26 PM

Document Has Been Signed on 02/22/2023 02:29 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:BALLARD VOCATIONAL SERVICE CENTERFACILITY NUMBER:
565801913
ADMINISTRATOR:LYDIA SATTIEWHITEFACILITY TYPE:
775
ADDRESS:3151 WEST 5TH STREET, #102TELEPHONE:
(805) 815-3233
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 60CENSUS: 15DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:LaToya TateTIME COMPLETED:
02:39 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required
annual visit at 1:30 p.m. This annual visit had a specific emphasis on infection control practices and procedures. The LPA spoke with the Day Program Supervisor LaToya Tate, and discussed the reason for the visit.

The LPA, and the Supervisor toured the physical plant areas inside from 1:40 p.m. to 2:00 p.m. to ensure there are no health and safety hazards.

RESTROOMS: The restrooms were observed to be clean, sanitary, and in operating condition. The LPA
observed sufficient amounts of soap and paper products, as well as hand washing signs.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good
condition. At the time of the visit, common seating areas and activity rooms furniture was observed to be in
good condition. The LPA observed the required postings in the kitchen and common hallway.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient seven-day supply of
non-perishable food. Cleaning supplies were observed to be locked and properly stored at the time of the
visit. Medications were observed to be locked in a locker in the supply room.

Continues on LIC 809C...
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BALLARD VOCATIONAL SERVICE CENTER
FACILITY NUMBER: 565801913
VISIT DATE: 02/22/2023
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INFECTION CONTROL: During today’s visit, the LPA spoke with the Supervisor regarding the facility’s
infection control practices. Upon entry, the facility has a point for symptom screening. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control is adequate.

No citations were issued during today’s visit. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC809 (FAS) - (06/04)
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