300605941-5-31-2019-06-CC-WPOT-BCPVGP-20190531162551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605941
Report Date: 05/31/2019
Date Signed: 05/31/2019 04:26:00 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 PERRY PROGRAM CENTER		FACILITY NUMBER:	300605941
ADMINISTRATOR:	SLEAR, ALEXIS		FACILITY TYPE:	840
ADDRESS:	19231 HARDING LANE		TELEPHONE:	(714) 968-6163
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	48	CENSUS: 27	DATE:	05/31/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Alexis Slear, Director		TIME COMPLETED:	04:50 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. The facility file was reviewed prior to this inspection. 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. Operating hours are 6:00 AM- 6:00 PM, Monday through Friday with periodic fun nights from 6:00 PM to 11:00 PM. This is a before and after school program that also operates during school breaks. The facility is currently licensed for 48 school age children in Room 37. An application requesting to provide care and supervision for 144 children, Monday through Friday 6:00 AM to 6:00 PM by adding Rooms 34 and 36 has been requested. Per Health and Safety Code 1596.806(1)(A), facility is exempt from Title 22 indoor/outdoor square footage and toilet requirements, as facility is located on school grounds- the campus of Joseph R. Perry Elementary School. Fire clearance from the Huntington Beach Fire Department has been received and approved for requested capacity of 144 school age children, with approval date 05/13/2019. This facility meets licensing requirements for the issuance of license to care for 144 children from 4.9 years of age through 12 years old from 6:00 AM to 6:00 PM, Monday through Friday in Rooms 34, 36, and 37. A license will be issued with effective date 06/24/2019. Upon arrival LPA observed: 27 school age children and 4 school age staff in Room 37, including the director. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. LPA was guided on a tour of the facility by Director, Alexis Slear. 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. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019

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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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 PERRY PROGRAM CENTER	FACILITY NUMBER: 300605941
	VISIT DATE: 05/31/2019

NARRATIVE

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Staff files for staff present during today’s inspection (four staff members) were reviewed for the required educational background and experience, immunization’s and mandated reporter training. At least one staff member present possesses current CPR/First Aid certifications, which expires 05/04/2021. Proof of immunization's against influenza (or written decline), pertussis and measles for all employees/volunteers 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.

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

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

Exit interview was conducted with Director, Alexis Slear. 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. 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) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019

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: YMCA PERRY PROGRAM CENTER	FACILITY NUMBER: 300605941
	VISIT DATE: 05/31/2019

NARRATIVE

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The director stated 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. There is a waiver on file to share the restrooms with the elementary school. The children’s bathrooms were observed to be in safe and sanitary operating conditions.

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. 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 is 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. The facility has conducted an emergency drill within the past six months.

Sign in/out procedure was reviewed for compliance. This facility utilizes an electronic sign in/out system, each authorized representative utilizes an individual code and the system records the time of the day. The facility is in compliance of school age sign in/out procedures as specified in 101529.1. 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.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019

LIC809 (FAS) - (06/04)

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