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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214141
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:52:52 AM

Document Has Been Signed on 12/04/2024 11:52 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:EASTER SEALS VENTURA CDCFACILITY NUMBER:
566214141
ADMINISTRATOR/
DIRECTOR:		CATHERINE RUTLEDGEFACILITY TYPE:
850
ADDRESS:10730 HENDERSON ROADTELEPHONE:
(805) 647-1141
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 122TOTAL ENROLLED CHILDREN: 122CENSUS: 80DATE:
12/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Misbah SaadTIME VISIT/
INSPECTION COMPLETED:
12:09 PM
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On 12/4/2024 Licensing Program Analyst (LPA) German Negrete made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with Center Director Misbah Saad, and discussed the purpose of the visit. During today’s inspection, LPA did a walk through of the Child Care Center(CCC) with Director. At the time of the inspection LPA observed 80 children and 18 staff members providing care and supervision.

On 11/19/2024, Director contacted via email Community Care Licensing (CCL) to self-report the following unusual incident : at approximately 10:12AM during play time at the Community Garden C#1 was being supervised by two staff members(S1 and S2). According to S1, C1 was walking and C1 lost train of thought and C1 could not maintain coordination on a obstacle course. S1 stated C1 fell and hit a wooden log, S1 walked over to C1 and observed a cut on the left side of the forehead. S1 observed blood and immediately applied pressure on C1's forehead. Director was contacted. The Director applied first aid and began to bandage C1's forehead. Area Director contacted first responder(911).

The Unusual Incident Report (LIC624) was received on 11/19/2024 via email.

Today LPA requested contact information for the parents of C1. The investigation will be ongoing.

Report was read and exit interview was conducted with Director.

Notice of site visit was provided.

Ana TolentinoTELEPHONE: (805) 218-0429
German NegreteTELEPHONE: 805-315-8362
DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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