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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270291
Report Date: 05/04/2023
Date Signed: 05/04/2023 02:19:35 PM


Document Has Been Signed on 05/04/2023 02:19 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:SOUTH COAST YMCA-OAKGROVEFACILITY NUMBER:
304270291
ADMINISTRATOR:LORI SILVAFACILITY TYPE:
840
ADDRESS:22705 SANBORNTELEPHONE:
(949) 360-1427
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY:180CENSUS: 0DATE:
05/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Charmaine CrutchfieldTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Bootorabi conducted a Case Management inspection of the facility due to an incident that was self-reported on 05/01/2023. There are not specific dates on when the incident occurred at this time. The allegation was child’s personal rights. The LPA met with the director Charmaine, and informed her the reason for the inspection. No children were observed upon LPA's entrance.
Census upon arrival
Children: 0 - Adults: 3

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's inspection, the LPA interviewed seven staff members, 3 children, and obtained copies of children roster.

Due to insufficient information available and further interviews needed, the aforementioned allegation needs further investigation.

No citations issued during today's inspection.

An exit interview conducted where the report was discussed with the facility representative. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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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