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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300605527
Report Date:
06/17/2019
Date Signed:
06/17/2019 05:42:46 PM
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:
CAPISTRANO BEACH CITIES YMCA-CONCORDIA
FACILITY NUMBER:
300605527
ADMINISTRATOR:
SLATTERY, CHRISTINE
FACILITY TYPE:
850
ADDRESS:
3120 AVENUE DEL PRESIDENTE
TELEPHONE:
(949) 498-1298
CITY:
SAN CLEMENTE
STATE:
CA
ZIP CODE:
92672
CAPACITY:
48
CENSUS:
14
DATE:
06/17/2019
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
04:00 PM
MET WITH:
Christine Slattery
TIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Connolly met with Director Christine Slattery for a case management inspection regarding a self reported incident that happened on 3/25/19 when a child in care reported to staff inappropriate talk and behavior by another child in care.
LPA accompanied by the director toured the facility inside and outside. Census was taken. There were 14 children present with 2 attending staff including the director. All children were actively engaged in the activities of the YMCA summer curriculum.
A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.
Two staff interviews were conducted as well as two children interviews. Pictures of the playground where the incident took place were taken. The director provided the Headcount and Attendance Roster dated 3/25/19. The K + class records provide evidence that on 3/25/19 the facility operated within ratio. Ratio was 1 to 9 on the playground. Additionally staff interviews and children interviews provide evidence staff followed supervision protocol during the transition time from the playground to receiving snacks.
The facility is within compliance during today's inspection.
Exit interview conducted. 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 $100.00.
SUPERVISOR'S NAME:
Judy Hanson
TELEPHONE:
(714) 703-2807
LICENSING EVALUATOR NAME:
Gesine Connolly
TELEPHONE:
(714) 703-2822
LICENSING EVALUATOR SIGNATURE:
DATE:
06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/17/2019
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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