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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801913
Report Date: 02/23/2024
Date Signed: 02/23/2024 04:04:44 PM

Document Has Been Signed on 02/23/2024 04:04 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
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: 16DATE:
02/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Lydia SattiewhiteTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a continuation of the required annual visit. LPA was assisted by Day Program Supervisor LaToya Tate and Program Director Lydia Sattiewhite.

During LPA's prior visit on 2/15/2024, LPA conducted a physical plant tour and health and safety check. During today's visit LPA conducted interviews, reviewed records and medications.

CLIENT INTERVIEWS AND RECORDS: LPA interviewed three clients; there were no concerns stated. LPA reviewed five clients' records. All records were complete with appraisals, physician reports, and admission agreements. LPA reviewed medications for four clients; medications appear to be given as prescribed.

STAFF INTERVIEWS AND RECORDS: LPA interviewed three staff who were all able to answer the questions appropriately; no concerns noted. LPA reviewed five staff records. All records included health screenings, current first aid/cpr certifications, and training records. LPA reviewed the Personnel Report (LIC500); all staff on the schedule are fingerprint cleared and associated to the facility.

DISASTER PLAN: LPA reviewed the facility's disaster plan which appeared to be complete and reviewed at least annually or as needed. The facility conducts monthly evacuation drills for both fire and earthquake.

No deficiencies were observed. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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