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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605527
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:43:21 AM

Document Has Been Signed on 03/13/2025 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CAPISTRANO BEACH CITIES YMCA-CONCORDIAFACILITY NUMBER:
300605527
ADMINISTRATOR/
DIRECTOR:		ROMAN, KARENFACILITY TYPE:
850
ADDRESS:3120 AVENUE DEL PRESIDENTETELEPHONE:
(949) 498-1298
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
03/13/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Executive Director Michelle Becerra, Director Karen Roman, and Assistant Director Ashley DardenTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Giselle Lucero conducted a case management visit at the facility for the purpose of adding a room and increasing the school age capacity. LPA met with Executive Director Michelle Becerra, Director Karen Roman, and Assistant Director Ashley Darden who gave a tour of the facility to LPA. There were no children present at the time of visit.

This facility is located on Concordia Elementary School grounds. Currently the facility is licensed for 48 school age children in room Y1.

The facility has requested to provide care and supervision to 96 school age children (TK-8th grade) in room Y1 and P23; Monday through Friday from 6:45 a.m to 6:00 p.m. All indoor and outdoor activity space utilized for the children was inspected today. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs and other activity supplies for the children. Drinking water is available in the classrooms via water filter system and they bring their own water bottles. Medications are kept in a storage cabinet. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. The outdoor playgrounds were inspected and are well maintained and free of hazards. Based on H&S code 1596.806(a), 1596.806 (a)(1), 1596.806 (1)(2) and 1596.806(d), the facility is exempt from square footage requirements.

Orange County Fire authority approved the facility for a total capacity of 96 preschool children in room Y1 and P23 approved on 03/11/2025, with the following special conditions or notes: Each room (Y1 and P23) are limited to 49 occupants due to single exits for each.

Based on today's inspection and fire clearance approval, the request of the facility to utilize room Y1 and P23 for 96 school age children is granted effective today’s date. Exit interview conducted and report was reviewed with Executive Director Michelle Becerra. A notice of site visit was given.

End of report.

Martha MalaneTELEPHONE: (310) 740-3022
Giselle LuceroTELEPHONE: 714-292-2922
DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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