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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604021
Report Date: 07/23/2019
Date Signed: 07/23/2019 08:49:47 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:YMCA EADER PROGRAM CENTERFACILITY NUMBER:
300604021
ADMINISTRATOR:CARRISSA DAINOFACILITY TYPE:
840
ADDRESS:9291 BANNING AVETELEPHONE:
(714) 968-3638
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:96CENSUS: 67DATE:
07/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Carissa Daino, DirectorTIME COMPLETED:
09:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) Port initiated an inspection of the facility. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

LPA observed 67 school age children, 14 staff members, and 2 parent volunteers. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

Upon arrival LPA the children were preparing for an outing. LPA was not able to complete inspection. Annual inspection will be continued at a later date.

There were no title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Director Carissa Daino. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
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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