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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613968
Report Date: 12/17/2019
Date Signed: 12/17/2019 03:23:15 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 PALMASFACILITY NUMBER:
300613968
ADMINISTRATOR:FLORES, DEBRAFACILITY TYPE:
840
ADDRESS:1101 CALLE PUENTETELEPHONE:
(949) 492-7482
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:30CENSUS: 22DATE:
12/17/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:DirectorTIME COMPLETED:
04:00 PM
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A case management inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek for the purpose of increasing capacity by adding the Elementary Steam Lab space for children's use. LPA met with director, Debra Flores. Census was taken. There were a total of 22 school age children with 2 staff on the YMCA ground. The facility has requested to provide care and supervision to 90 school age children ages 4.9 to 12 years of age Monday to Friday from 6:45 am to 6:00 pm. The facility is currently licensed for 30 children in room # 8. Steam lab space (room # 9) was measured and inspected. The measurement of the steam lab is approximately 1152 square feet which accommodates additional 32 school age children. There is a kitchenette adjacent to this room. Carbon Monoxide Detector was verified. Fire clearance has been approved and received in our office for a total of 60 children. This YMCA facility is located at Las Palmas Elementary School. The YMCA is using the school playground and restrooms. The playground and the number of restrooms are exempt from measuring and counting. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. The director was reminded to make sure the Steam Lab is free of any hazardous items before YMCA children use this space. The Notice of Site Visit was posted. 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. The licensee was provided a copy of their appeal right (LIC 9058 1/2016) 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. First level appeal is to Regional Manager, address is above on the report. In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12. An updated license is issued today to reflect the requested capacity for 60 children per Fire Department approval.
This report ends here.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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