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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207810
Report Date: 03/08/2022
Date Signed: 03/08/2022 11:17:55 AM

Document Has Been Signed on 03/08/2022 11:17 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VUSD - WILL ROGERS JUMPSTARTFACILITY NUMBER:
566207810
ADMINISTRATOR:LORETTA GALAVIZFACILITY TYPE:
850
ADDRESS:316 HOWARD ST.TELEPHONE:
(805) 641-5374
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 15DATE:
03/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sonia SaucedoTIME COMPLETED:
11:31 AM
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On 3/8/2022 at 10:00 AM , Licensing Program Analyst (LPA) Austin Rios and (LPA) Rona Chavez conducted an unannounced Case Management inspection. LPA met with facility Director Sonia Saucedo and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 15 children and 3 staff in care at the time of the inspection.

On 2/17/2022 facility self-reported that on 2/16/2022, at 3:35pm, Child (C1) advised teacher (T1) that Child mask had ripped. Teacher (T1) asked Child (C1) what should he do and Child stated tape it. T1 stapled the mask and put tape over the staple to prevent C1 from getting cut from the staple. On 2/17/2022 after a report was made, a Police Officer arrived to the school requesting to speak with T1. The officer advised T1 that he was following up on an incident that happened on 2/16/2022 between 3:35-3:45pm concerning C1 and a mask. Police officer interviewed another staff member at the facility.

Today, LPAs inspected the area and observed where the incident took place as well as interview staff. The Director reported the incident and submitted the incident report to the Department as required. During the inspections LPAs observed extra mask available.

Given the information obtained, Facility is being given a technical violation for Personal Rights due to a new mask not being provided to child.
California Code of regulation, Title 22, Division 12 regulation 101223(a)(2) Personal Rights

Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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