300605527-1-9-2020-06-CC-KDEI-BKP2BJ-20200109161514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605527
Report Date: 01/09/2020
Date Signed: 01/09/2020 04:15:25 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: 27	DATE:	01/09/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator Slattery Christine		TIME COMPLETED:	04:40 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	Licensing Program Analyst (LPA), Ketki Desai conducted an on-site inspection for the purpose of an Annual inspection. LPA and Director Slattery Christine toured the facility inside and outside, floor and yard plan (LIC 999) were verified. This is a School Age program, held in assigned room (Y26) it is a only portable used by YMCA program. The school age program is on the premises of Concordia Elementary school under the Capsitrano Unified School District. The program has 2 sessions early morning session is from 6.45 am to 8.00 am (Monday to Friday) children are dropped off by parents and assigned staff present, walks them to the school. The afternoon session begins at 12.55 PM only on Tuesdays while on other week days it begins at 2.10 PM. During full day sessions the operating hours are from 6.45 am to 6.00 PM. There was a total census of 27 school age children with 2 fully qualified teachers and an assistant with Administrator on site to provide additional support. Per the facility roster 43 school age children are enrolled. School Age children enrolled in the program are dropped off and picked up by the staff. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Observed to be stored in locked cabinets, inaccessible to children. Poisons/Hazardous Items are not kept on the premises. School age children are served PM snacks on arrival, during full day session AM/PM snacks are served and lunch is brought from home which is stored in their individual cubbies. Food prep areas were clean and sanitary. Food is properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children, via water dispenser some of the enrolled children also bring in their own water bottles. The children's bathrooms are clean and sanitary and are shared by the school children.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-CONCORDIA	FACILITY NUMBER: 300605527
	VISIT DATE: 01/09/2020

NARRATIVE

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Waiver in place .

The facility has conducted an emergency drill within the past six months (12/27/19) The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility office .

Staff files were reviewed present during the facility inspection this date, Four staff files were reviewed. Health screening and immunization's as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a Child Care center day care if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for (staff) were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires in May 2021

Facility Director was informed that the Criminal Record Statement (LIC 508) has been
updated, and the facility must now use the new form with revised date 7/15. Facility Director was also informed that the LIC 508 must be submitted with all Criminal Background Clearance.

Six Children's records were reviewed, and there was a separate, complete and current record for each child. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed. Facility has the Electronic Sign in and out procedure in place.

This facility provides Incidental Medical Services - (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
IMS medications are stored in a locked cabinet in a red locked bag and would be administered per medical orders and log shall be maintained. Currently there is one enrolled child who receives IMS services.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-CONCORDIA	FACILITY NUMBER: 300605527
	VISIT DATE: 01/09/2020

NARRATIVE

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The outdoor activity space was inspected for compliance. The play yard is located in front of the portable surrounded by school building, it is the enclosed by school complex buildings along with a soccer field at the end with fence and surrounding wall. The surface of the outdoor activity space was well maintained and free of hazards. The outdoor equipment and toys were in good repair and free of sharp edges. Children do have access to the soccer field. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.
Drinking water in the outdoor activity space is provided by Water fountain/ as well as personalized water bottles. .

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The Facility Director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

In the areas that were evaluated, no deficiency were observed under California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was completed with Facility Assistant Director. The report was reviewed and discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

LIC809 (FAS) - (06/04)

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