300613968-5-13-2019-06-CC-GCOY-BC639N-20190513180324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613968
Report Date: 05/13/2019
Date Signed: 05/13/2019 06:03:30 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:	CAPISTRANO BEACH CITIES YMCA-LAS PALMAS		FACILITY NUMBER:	300613968
ADMINISTRATOR:	CESARIO, ALICIA		FACILITY TYPE:	840
ADDRESS:	1101 CALLE PUENTE		TELEPHONE:	(949) 492-7482
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY:	30	CENSUS: 18	DATE:	05/13/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	04:05 PM
MET WITH:	Alicia Cesario		TIME COMPLETED:	06:15 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 annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Connolly. The facility file was reviewed prior to this inspection being conducted. Facility was toured inside and outside. Census was taken. There were 18 children in care with 3 attending staff. All children were actively engaged in the activities of the YMCA. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. 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. Operating hours are Monday through Friday 6:45 AM -6:00 PM. The facility is located on the campus of Las Palmas Elementary in Room 8. The facility appeared clean and orderly. The toys, floors, desks and other equipment in Room #8 appeared clean and in good repair. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are locked in a custodian area. Food is prepared on site; snacks are provided. Food prep areas appear clean and sanitary. Food is properly stored. Menu is posted. There is drinking water available to children both indoors and outdoors. The children bathrooms are clean and sanitary. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. At least one staff member present possesses current CPR/First Aid certifications, which expire 8/24/2020. The facility has conducted an emergency drill within the past six months. Documentation was submitted. The playgrounds are completely fenced. The playground equipment appeared in safe condition, and play areas are free from hazards. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. Continued on page two

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

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: CAPISTRANO BEACH CITIES YMCA-LAS PALMAS	FACILITY NUMBER: 300613968
	VISIT DATE: 05/13/2019

NARRATIVE

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Sign in/out procedure was reviewed for compliance. The YMCA uses an electronic system for sign out. Children are signed in by staff and status is transferred to the electronic system.
Children and staff files were reviewed for compliance. Proof of immunity against pertussis, influenza (or written declination), and measles for all employees/volunteers were reviewed for compliance with SB 792.
Staff files were reviewed for certificates all staff has had the mandated reporter training. Certificates were present in each staff file.

During today’s inspection the LPA discussed incidental medical services with the director. The director said there are no incidental medical services being provided at this time. 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

The director provided copies of updated Personnel Report (LIC 500) and updated Emergency Disaster Plan for Child Care Centers (LIC 610) as well as an updated Designation of Facility Responsibility (LIC 308.

In the areas that were evaluated no deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100.00. The 'Notice of Site Visit' ' must be posted on or adjacent to the door.
All licensing reports are public information and must be made available upon request.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019

LIC809 (FAS) - (06/04)

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