197412503-5-24-2022-17-CC-DTHN-CEQT2V-20220524142121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412503
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:21:26 PM

Document Has Been Signed on 05/24/2022 02:21 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	TRIUNFO YMCA- SUMAC ELEMENTARY SITE		FACILITY NUMBER:	197412503
ADMINISTRATOR:	ABIGAIL PECH		FACILITY TYPE:	840
ADDRESS:	6050 N. CALMFIELD		TELEPHONE:	(818) 889-8857
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	90	CENSUS: 0	DATE:	05/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Sonia Garcia		TIME COMPLETED:	02:39 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 24, 2022, Licensing Program Analysts (LPA) Dean Thompson conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with Director Sonia Garcia and advised the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were zero children in care at the time of the inspection. LPA observed required licensing documents mounted on the wall inside the classroom. Last fire drill was conducted on 5/20/2022. Two classrooms are being used for the after school program Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care. LPA observed enough restrooms available for children to use. LPA did not observe any hazards/toxins items accessible to children. First Aid kits were observed inside the classroom. Facility provides afternoon snacks and has filtered water available in both classrooms. The outdoor playground has an ample amount of space for children to play. LPA observed the playground has age-appropriate toys and activities. There are no bodies of water present during todays inspection. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA observed staff files to be complete and current. CPR current with an expiration date of 9/2023. Staff mandated reporter certification are all current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: TRIUNFO YMCA- SUMAC ELEMENTARY SITE	FACILITY NUMBER: 197412503
	VISIT DATE: 05/24/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

No deficiencies were cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director Sonia Garcia.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

LIC809 (FAS) - (06/04)

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