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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370454
Report Date: 04/19/2022
Date Signed: 04/19/2022 12:01:48 PM


Document Has Been Signed on 04/19/2022 12:01 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CLUB JFACILITY NUMBER:
304370454
ADMINISTRATOR:MARTIN, AUDRAFACILITY TYPE:
840
ADDRESS:1 FEDERATION WAY, SUITE #200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY:75CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Julie Holdaway, Assistant Exe Director & VPTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of adding rooms: Green Room, Dressing Room A, Dressing Room B, Teen Center, Teaching Kitchen, Art Gallery, Basketball Courts, Conference Room A, Conference Room B, Large Aerobics Studio, Maccabi Room, Room 348, JCC Conference Room, Karp Board Room, and Computer Lab, no change in capacity. LPA Torrence met with Julie Holdaway, Assistant Executive Director & Vice President and toured the facility. Census was taken. During today’s inspection, there were no school-age children and two staff present. Facility operation hours are as follows: Monday-Friday; 1:00 p.m.-6:00 p.m.

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

Currently facility is licensed for 75 school age children (5-year-old to 11-year-old) in rooms: Children’s Room, Dressing Room, Art Room, and Conference Rooms C&D.

The following was observed in added School-Age Rooms:
· Age appropriate furniture and equipment
· Room is well lighted with ventilation.
· Drinking water is available through water coolers and personal water bottles
· Sign in and out procedures was reviewed

Total added indoor space for School Age: 629.24 divided by 35 = 18 children
Total previously approved indoor space for School Age: 4150 divided by 35= 118 children

Sinks: 11 x15= 165 children
Toilets: 8 x 15= 120 children
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: CLUB J
FACILITY NUMBER: 304370454
VISIT DATE: 04/19/2022
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Outdoor space: Playground is completely enclosed by a fence. The area used by Club J will be marked off by cones. Outdoor activity area is supplied with age and size appropriate equipment. Shade is provided by patio awnings. Drinking water is provided by coolers, and personal water bottles.

Total outdoor activity space: 35970 divided by 75 = 480 children

Based on today’s Indoor and Outdoor measurements, sink & toilet availability, center has enough activity space to support the requested capacity of 75 School Age children.

Fire clearance approval has been received from Orange county Fire Authority approving the added rooms, no change in capacity.

Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100.

Appeal rights presented to the Director.

Exit interview conducted.

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2