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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607120
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:22:56 PM


Document Has Been Signed on 02/21/2024 04:22 PM - 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CAPISTRANO BEACH CITIES YMCA-AMBUEHLFACILITY NUMBER:
300607120
ADMINISTRATOR:SPABERG, JONASFACILITY TYPE:
840
ADDRESS:28001 SAN JUAN CREEK RD.TELEPHONE:
(949) 493-5327
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:75CENSUS: 41DATE:
02/21/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:DirectorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite inspection for the purpose of required -3 year inspection. LPA met with director Jonas Spaberg in Y2 (210) who was supervising 28 school age children at 2:45pm. The director stated additional staff will arrive soon. Another group of 13 children were outside with one staff eating snack. According to director, he has been with 32 children since 1:30 pm. since the school was early dismissed. There were no children in Y1 (P12). LPA toured the facility inside and outside. District Manager Michelle Becerra, and one more staff arrived around 3:15 pm. The floor and yard plan (LIC 999) were checked. During the inspection it was determined the facility is not operating within its licensed capacity and not within compliance of staffing ratios. Facility hours are 6:45 a.m.- 6:00 p.m., Monday through Friday. Parents sign their children in and out electronically.

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 (cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The facility provides morning, afternoon snacks to children. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. Drinking water is available to children indoors by water containers that children bring from home and the facility fill them up with filtered water. There are no sinks inside the rooms. Children wash their hands in the sinks located in the restrooms located on the elementary ground.
The facility has conducted an emergency drill within the past six months, last drill was in 2/9/2024.
The facility has a working carbon monoxide detector mounted on the wall. Facility met all posting requirement Continue to page 2
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-AMBUEHL
FACILITY NUMBER: 300607120
VISIT DATE: 02/21/2024
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The outdoor activity space was inspected for compliance. The playground on the elementary site is for children's use and it is all fenced. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material under and around the climbing equipment such as slides appeared to be enough to absorb falls. Drinking water in the outdoor activity space is provided by water containers children brought from home and the facility fills them up by filtered water if needed. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility.

Staff files were reviewed for staff present during the facility inspection on this date, 3 staff files were reviewed. Health screening and immunization 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 childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and were in 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 are in compliance.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 5 children's files were reviewed for documentation of the child’s 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 when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance.
Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day. This procedure is electronically.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-AMBUEHL
FACILITY NUMBER: 300607120
VISIT DATE: 02/21/2024
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5-years after the date of the first test. LPA verified that the lead testing was not completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. However the facility is using drinking filtered water from water dispenser from a private water company. There are no sinks in the rooms for drinking or food preparation. The facility representative was provided a copy of lead testing from the water company that showed no sign of lead. Facility has submitted attestation to Orange County Office for this purpose.
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301(voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at:https://www.ada.gov/resources/child-carecenters

The director Jonas Spaberg was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-AMBUEHL
FACILITY NUMBER: 300607120
VISIT DATE: 02/21/2024
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to receive email communications.

The director Jonas Spaberg was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the


email address provided. Please complete the survey and share your inspection experience. If
you have any questions regarding the process or CARE tools, please send email inquiries to
inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its
tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

In the areas that were evaluated, the following deficiencies were observed of the California Code of Regulations, Title 22, Division 12 on this inspection. Please see LIC 809D. A notice of site visit was given to director Jonas Spaberg and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to post will result in Civil Penalties of $100.00. Exit interview conducted and report was reviewed with the director Jonas Spaberg. LPA Malek informed the director Jonas Spabergi that this report dated 2/21/2024 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Malek informed the director Jonas Spaberg to provide a copy of this licensing report dated 2/21/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

End of report.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/21/2024 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-AMBUEHL
FACILITY NUMBER: 300607120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101516.5(b)(1)
Teacher-Child Ratio
(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation at 2;45 pm, the licensee did not comply with the section cited above that one staff was supervising 28 children in Y2 which poses an immediate health, safety risk to persons in care. Staff stated help will arrive soon. LPA observed another staff arrived at 3:15 pm.
POC Due Date: 02/22/2024
Plan of Correction
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The director agreed to send a written plan of correction how the facility will prevent such incidents for the future to meet the teacher/child ratio which is 1 teacher to 14 school age children. The plan will be sent to LPA's email by 2/22/24
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 02/21/2024 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CAPISTRANO BEACH CITIES YMCA-AMBUEHL
FACILITY NUMBER: 300607120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.2(e)
Teacher Aide Qualifications and Duties
(e) An aide shall work only under the direct supervision of a teacher.

This requirement is not met as evidenced by:
Deficient Practice Statement
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On 2:45 pm based on observation and record review, the licensee did not comply with the section cited above having an aid with 13 children outside on the bench area poses a potential health, safety risk to persons in care. Another staff arrived at 3:15 pm.
POC Due Date: 02/22/2024
Plan of Correction
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The director agreed to send a plan of correction including LIC 500 with staff hours to LPA's email by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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