300607105-6-8-2020-06-CC-KDEI-BQDRV5-20200608132058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300607105
Report Date: 06/08/2020
Date Signed: 06/08/2020 01:22:47 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:	SOUTH COAST YMCA- MARION BERGESON ELEMENTARY		FACILITY NUMBER:	300607105
ADMINISTRATOR:	PHAN, MICHELLE		FACILITY TYPE:	840
ADDRESS:	25302 RANCHO NIGUEL		TELEPHONE:	(949) 643-0721
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	135	CENSUS: 52	DATE:	06/08/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Michelle Becerra (Phan)		TIME COMPLETED:	01:30 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’s) Ketki Desai conducted an unannounced Tele inspection via Face time due to current pandemic Covid 19. The inspection was following the Capacity increase requested by the program. Capacity has been requested to increase from 135 school age children to 180 school age children, by adding an additional classroom P-25 along with the formerly approved and licensed rooms Y-1, Y-2, P-26 and the Multipurpose Room. Fire Clearance for capacity 180 was issued 2-20-2020 by Orange county Fire Authority and also Marion Bergeson Elementary school has given the Bergeson YMCA permission to utilize Portable P-25. . Director Michelle Becerra ( Phan) accompanied the LPA on a tour via Face time of the facility. Present at the time of the tour were 52 children with 7 staff . They were 4 groups of 9 school age children with one teacher in each group and two groups of 8 school age children with one teacher in each group. The groups were observed to be in separate areas. The teachers have a staggered schedules through the day to meet the current pandemic requirements. Currently there are no children on the school campus. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance. Facility operating hours are from 6.45 am to 6.00 PM ( Monday to Friday) /Age group served: 4-9 years ( School age children) The facility tour via face time was conducted in each of the three classrooms and outside play yards as per the facility sketch. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. All the assigned classrooms utilized were observed to be clean and orderly. All the passage ways, ramps were open free of obstruction. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored locked in a cabinet, inaccessible to children.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020

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: SOUTH COAST YMCA- MARION BERGESON ELEMENTARY	FACILITY NUMBER: 300607105
	VISIT DATE: 06/08/2020

NARRATIVE

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Facility provides AM/PM snacks, which are stored in a locked cabinet. Lunch is provided by the parents. Snack menu is posted. Age appropriate toys, educational material were clean and organized for easy access to the children. Facility floors, desks and other equipment appeared clean. There is drinking water dispenser in each classrooms, some personal water bottles were also observed. Children have access to drinking water both indoors and outdoors ( water fountain). The children's bathrooms are within proximity to classrooms and playground.

LPA also observed new procedures being implemented for ongoing sanitization and cleaning procedures in place. Hand sanitizing dispensers are utilized and hand washing is encouraged through the day. Temperature checks are completed upon arrival.

The outdoor playground fencing is in place The playground equipment appeared in safe condition and play area is free from hazards. There is sufficient cushioning underneath climbing structures and play equipment to absorb falls. Each play yard has sufficient shade ( Canopy )was set up for small group to engage in outdoor activities.

Facility has Electronic sign in and out method, a table is set up with the electronic device and sanitizers to complete the sign in procedure.

Area behind the Director's desk in (Y-2) shall be used as an isolation area. First aid kits and bags are in each of the designated classrooms. Medication box is placed in the locked cabinet and is administered by the staff. There are two children in Y-2 who receive Incidental Medical services and documentation is maintained in their files.

Children do not nap in this program.

.The facility has conducted an emergency drill within the past month. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. Assistant Director possesses current CPR/First Aid certifications which is valid through December 2020. Per Director all the staff are current on the required CPR/First Aid training.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020

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: SOUTH COAST YMCA- MARION BERGESON ELEMENTARY	FACILITY NUMBER: 300607105
	VISIT DATE: 06/08/2020

NARRATIVE

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Director has documentation: proof of immunization's against pertussis, influenza (or written declination) and measles for all employees. Staff has completed mandated reporter training, completed on March 5th 2020. Certificates of completion are in each staff member's file.

Facility meets the posting requirements.

Incidental Medical Services (IMS) policy was discussed. This facility cares for children who need incidental medical services. 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. 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

All licensing reports are public information and must be made available upon request. This report was reviewed and discussed with the licensee.

The facility was in compliance with Title 22 requirements at the time of the inspection. A license will be issued for the capacity requested after a final review. ( Capacity increase : 180- School age children).

The report was emailed to the Director , the Read Receipt shall be utilized in Lieu of the Signature for this report.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020

LIC809 (FAS) - (06/04)

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