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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845932
Report Date: 01/14/2021
Date Signed: 06/02/2021 12:12:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEMFACILITY NUMBER:
334845932
ADMINISTRATOR:CARRILLO,YOLANDAFACILITY TYPE:
840
ADDRESS:1041 FULLERTON AVETELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:24CENSUS: 0DATE:
01/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tammy EllisTIME COMPLETED:
04:00 PM
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Due to COVID-19 the tele-inspection is being conducted via Google Duo. Licensing Program Analysts (LPAs) Corey Hall and Kim Leung, toured proposed school age center, inside and out. The days and hours of operation will be: 6am to 6pm Monday through Friday. The facility is using an existing classroom and playground from the Lincoln Fundamental Elementary school. Per Title 22 regulations the facility is exempt from measurements. Therefore, no measurements will be taken. The facility is also exempt from the toilet and sink ratios. However, the facility has adequate toilets, sinks, and water fountains to accommodate the requested capacity of 24 school aged children. The facility is currently closed and will open when given permission from the school district.

School-Age Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 24 children.

School-Age Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 24 children.

Limiting factor for school-age capacity is the classroom. School-age capacity is limited to 24 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· One sink and one drinking fountain supply drinking water in the indoor activity space
· Playground is enclosed by an appropriate fence
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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· Outdoor activity area is supplied with age and size appropriate equipment
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play area by outdoor drinking fountains
· Food preparation will be completed at an offsite kitchen located at a non-childcare facility
· The corner of the classroom next to the teacher’s desk will serve as the isolation area for ill children temporarily until parents arrive
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area
· Medication will be stored in a lock box inside of the refrigerator or locked cabinet and is inaccessible to children
· Storage area for toxins and poisons is locked.
· The Licensee states that they are providing Incidental Medical Services at this time. LPA informed the Licensee that prior to providing any incidental medical services that a written plan must be submitted to the licensing office.
· Medication administration forms were reviewed
· First Aid kit is complete
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· A review of staff records on 01/14/2021 indicates that the Licensee or designated individual who is required to have caregiver background checks have received criminal record and child abuse index clearances or exemptions, all other staff have required documentation in their personnel files.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· The "Notification of Parent's Rights" (PUB393 dated [8/02]) poster was provided to the applicant and they were advised that it must be posted in an area of the facility accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The applicant was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· Applicant will wait until facility opens to determine IMS needs Incidental Medical Services (IMS) policy was discussed. 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was also reviewed and discussed:
v AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing reports for Child Care Facilities on it’s internet Web site. This information is to be updated at least monthly on the website and will span the preceding five-year period.
v AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
v AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every child care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections
v - SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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v - AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v - SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1596.7995(a)(1) - Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year.
v - AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
v NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
v Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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v Please subscribe at childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

An exit interview was conducted and during the interview, the applicant, Kara Pingel confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The following items need to be completed/corrected prior to a license being issued:

1. Applicant will submit a written waiver to allow shared use of the restrooms between the childcare program and the school.

2. Applicant will submit a written waiver to allow shared use of the playground between the childcare program and the school.

3. Applicant will provide sufficient cubbie space for the children to store their belongings and email pictures to LPA Hall as proof of completion.

4. Applicant will finish setting up the classroom and email pictures to LPA Hall as proof of completion.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: YMCA YOUTH CENTER AT LINCOLN FUNDAMENTAL ELEM
FACILITY NUMBER: 334845932
VISIT DATE: 01/14/2021
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1. The school does not allow parents on the campus. Parents would need to make appointments prior to visiting the campus. Applicant will add this information to their handbook, admission policy or write a letter. The completed document will be provide to parents and one copy will be sent to Licensing.

2. Applicant will submit a written letter for this facility to associate all personnel to this facility.

3. The New CEO, Audrie Echnov will assume her duties on Monday 1/18/21. A personnel packet must be submitted for the CEO. All documents were discussed with the Applicant.

4. A control of property form must be provided by submitting a copy of the lease agreement.

5. A Flu shot or letter of declination for Maureen Harrigan.

6. An updated Mandated Reporter certificate for Maureen Harrigan.

7. An Annual Training plan must be submitted.

8. LIC 309 Fill in the top four Board members and list their term expiration.

9. LIC 401 fill in the net profit on line 38.

Once all corrections have been made, with proof sent to licensing the application along with the fire clearances will be submitted for approval with a maximum capacity of 24. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. An exit interview was conducted, and a copy of this report was provided to the applicant on this date via email.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2021
LIC809 (FAS) - (06/04)
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