300605643-9-17-2019-06-CC-WPOT-BG4UD6-20190917152900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605643
Report Date: 09/17/2019
Date Signed: 09/17/2019 03:29:11 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:	YMCA MOFFETT PROGRAM CENTER		FACILITY NUMBER:	300605643
ADMINISTRATOR:	JAMIE ALLS		FACILITY TYPE:	840
ADDRESS:	8800 BURLCREST		TELEPHONE:	(714) 964-1870
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	138	CENSUS: 48	DATE:	09/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jamie Alls, Director		TIME COMPLETED:	04:00 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	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. 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. This a before and after school program that also operates during school breaks. Operating hours are 6:45 AM- 6:00 PM, Monday through Friday. There are occasional Friday night hours of 6:00 PM to 10:00 PM. This facility is located on the campus of S.A. Moffett Elementary School and operates in Room Y1 and Y2. Upon arrival LPA met with Director Jamie Alls who guided LPA on a tour of the facility. There were 28 school age children and 4 staff members (including the director) in Room Y1 and 20 school age children and 2 staff members in Room Y2. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water onsite. LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. Poisons/Hazardous Items are not stored on site and none were observed during today's inspection. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. The children’s bathrooms were observed to be in safe and sanitary operating conditions. There is a waiver on file to use the elementary school bathrooms. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: YMCA MOFFETT PROGRAM CENTER	FACILITY NUMBER: 300605643
	VISIT DATE: 09/17/2019

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
26
27
28
29
30
31
32

Page 2 of 3

All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Food is prepared on site; snacks are provided by the facility. Food prep areas appear clean and sanitary. Food is properly stored. Solid waste receptacles have a tight-fitting cover and are in good repair. There is drinking water available to children both indoors and outdoors. A current menu is posted in a prominent location viewable by an authorized representative. The facility representative stated menus are dated, kept on file for 30 days and viewable upon request. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.

There is a waiver on file to share the elementary school playground. The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient rubber cushioning underneath climbing structures and/or play equipment to absorb falls.

Sign in/out procedure was reviewed for compliance. This facility utilizes electronic sign in/out system, each authorized representative utilizes and individualized code. This facility is within compliance of school age sign in/out requirements, a staff members signs in each child upon release from the on site elementary school. A random sample of ten children's files were reviewed for information including but not limited to the name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached and a health history form.

Staff files for staff present during today’s inspection were reviewed for a health screening, immunization’s and mandated reporter training. At least one staff member present possesses current CPR/First Aid certifications, which expires 06/18/2020. Proof of immunization's against influenza (or written decline), pertussis and measles for employee's present during today's inspection were reviewed for compliance with SB 792. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Proof of completion as required by AB 1207 was observed in staff files. The name of the child care center director or fully qualified teacher designated to act in the director’s absence shall be reported to the department within 10 days of a change.
(Continued on Page 3)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: YMCA MOFFETT PROGRAM CENTER	FACILITY NUMBER: 300605643
	VISIT DATE: 09/17/2019

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
26
27
28
29
30
31
32

Page 3 of 3

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, 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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. A copy of the Department of Social Services Lead information brochure was provided and explained to the director.

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

Exit interview was conducted with Director, Jamie Alls. 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. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3