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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605119
Report Date: 09/04/2019
Date Signed: 09/04/2019 10:03:55 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 SMITH PROGRAM CENTERFACILITY NUMBER:
300605119
ADMINISTRATOR:MCNEILL, MIRANDAFACILITY TYPE:
840
ADDRESS:770 17TH STTELEPHONE:
(714) 960-5553
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:90CENSUS: 0DATE:
09/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director Miranda McNeillTIME COMPLETED:
10:30 AM
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A case management inspection was conducted at this Early Childhood Educator Settings by Licensing Program Analyst (LPA) Ho. No children were present during today's inspection due to In-service Staff Training Day.

LPA met with director Miranda McNeill and discussed the unusual incident report in which Staff #1 (See Confidential Names List LIC811) reported that child #1 disclosed to her staff 2 may have violated the child's 1 personal rights. The facility representative reported the incident to the licensing office on 6/14/19.

This unusual incident was investigated by Investigator Nikki Vo from Investigation Branch (IB). Based on the interviews conducted during the investigation and the information obtained, there is not a preponderance of evidence to support child 1's disclosure.

The facility is within compliance during today's inspection.

Exit interview was conducted. The Notice of Site Visit was posted. Director 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.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019
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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