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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270707
Report Date: 12/04/2019
Date Signed: 12/04/2019 03:11:17 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-DON JUAN AVILAFACILITY NUMBER:
304270707
ADMINISTRATOR:HOYT, TAMARAFACILITY TYPE:
840
ADDRESS:26278 WOOD CANYONTELEPHONE:
(949) 360-5907
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY:135CENSUS: 127DATE:
12/04/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:DirectorTIME COMPLETED:
03:45 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 school library space for children's use. LPA met with director, Tamara Hoyt. Census was taken. There were a total of 127 school age children with 10 other staff. The facility has requested to provide care and supervision to 185 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 135 children in rooms Y1, Y2, Y3, and Multipurpose Room (MPR). School library was measured and inspected. The measurement of the school library is approximately 3713 square feet which accommodates additional 106 school age children. Fire clearance has been approved and received in our office for 185 children. This YMCA facility is located at Don Juan 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. Floors were inspected for safety and cleanliness. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment.
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 of 185 children.
This report ends here.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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