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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801913
Report Date: 02/15/2024
Date Signed: 02/16/2024 08:20:39 AM

Document Has Been Signed on 02/16/2024 08:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:BALLARD VOCATIONAL SERVICE CENTERFACILITY NUMBER:
565801913
ADMINISTRATOR:REBECCA GUTIERREZFACILITY TYPE:
775
ADDRESS:3151 WEST 5TH STREET, #102TELEPHONE:
(805) 815-3233
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 60CENSUS: 18DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:LaToya TateTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required
annual visit at 2:05 p.m. The administrator was not in, clients were leaving for home and staff were getting ready to leave as well. LPA met with the Day Program Supervisor LaToya Tate, and discussed the reason for the visit. LPA toured the physical plant with the supervisor to ensure there are no health and safety hazards. All four fire extinguishers were last serviced 1/30/2024 and appeared fully charged. The carbon monoxide and smoke detectors were tested and functioned properly during the visit.

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. LPA tested the hot water temperature to be 115.9*F.
COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good
condition. At the time of the visit, furniture and equipment were observed to be in good condition. LPA observed the required postings in the kitchen and common hallway.
KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of
non-perishable food and water. 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.
INFECTION CONTROL: LPA spoke with the Supervisor regarding the facility’s infection control practices. 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 a client is ill. The facility’s policies and procedures as it pertains to infection control is adequate.

LPA will return at a later date to continue this annual inspection. No citations were issued during today’s visit. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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