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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702975
Report Date: 02/18/2020
Date Signed: 02/18/2020 12:48:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SANTA MARIA VALLEY YMCAFACILITY NUMBER:
421702975
ADMINISTRATOR:KELSEY FERGUSONFACILITY TYPE:
850
ADDRESS:3400 SKYWAY DRIVETELEPHONE:
(805) 937-8521
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:34CENSUS: 23DATE:
02/18/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Kelsey FergusonTIME COMPLETED:
12:50 PM
NARRATIVE
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On February 18, 2020, at 12:01 PM Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Case Management inspection at the abovementioned Child Care Center (CCC). LPA met with Kelsey Ferguson, Director of the CCC and discussed the purpose of the inspection, namely, the inspection was a follow up to a self reported incident involving Child #1 touching Child # 2's genital area. LPA, in company of the Director toured the interior and exterior of the CCC. LPA observed twenty 23 children in care at the time of the inspection.

LPA discussed the incident with the Director and observed the portion of the outdoor play area where the incident occurred. The Director noted two staff members were in the play area providing supervision when the incident occurred. Thirteen children were present. The incident occurred inside of a large tractor tire resting in the play area. Staff members were able to recount Child #1 and Child # 2's interactions prior to entering the tractor tire. The incident occurred minutes after Child #1 and Child #2 entered the tractor tire. The incident was reported to staff members immediately after occurrence by Child #2

The parent/guardian of Child #1 and Child #2 were immediately notified after the incident and the incident was reported to Child Welfare Services.

Child #1 was removed from the CCC following the incident. The removal trailed discussions between the Director, the YMCA's Administration and the center's behavior therapist regarding the incidents as well as other adverse incidents concerning Child #1. The Director referred the parent/guardian of Child #1 to the Child Abuse Listen Meditation program. The Director also referred the parent/guardian of Child #2 to the Good Touch Bad touch training present by the North County Rape Crisis Center. The Director met with staff members and discussed more vigilant supervision near the play area in proximity to the tractor tire. The Director informed the LPA of the center intention to covert the largest tractor tire into a planter.
CONT. 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SANTA MARIA VALLEY YMCA
FACILITY NUMBER: 421702975
VISIT DATE: 02/18/2020
NARRATIVE
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Based on the information obtained from Director as well as the LPA's observations and record reviews, LPA determined there were no deficiencies and the Director and CCC functioned in accordance with Title 22 regulations.

No deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2