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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702975
Report Date: 08/12/2020
Date Signed: 08/12/2020 09:54:59 AM

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: 0DATE:
08/12/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kelsey ApkarianTIME COMPLETED:
10:00 AM
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On August 12, 2020 at 9:00AM, Licensing Program Analyst (LPA) Christian Patterson conducted an announced Case Management Inspection to the facility in order to complete an Increase of Capacity Inspection. Due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection will occur. LPA met with Program Administrator Kelsey Apkarian and explained the purpose of the visit. A tour of the facility was conducted inside and outside of the facility. There were no children present at the time of the inspection.

Facility submitted an application to the Community Care Licensing (CCL) requesting an increase in capacity for preschool children from 34 to 44 preschool children. The facility currently has one room and would like to add additional room space to their license. On July 30, 2020 the Santa Barbara County Fire Department inspector conducted a fire inspection. The facility received a fire clearance approval for the increase of capacity.

The measurements for the two classrooms that are being added are as follows:
Classroom one: 1,140.34/35 = 34 children
Classroom two: 343.13/35 = 10 children

Facility has a total of 4 sinks, 6 toilets, and 2 urinals. Facility has enough toilets, sinks and urinals to meet the needs to the children.

Facility has one large yard which will be used. Measurements for the outside space are on file.

The center meets Title 22 Division 12 requirements.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
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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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: 08/12/2020
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License capacity increase will be effective today, August 12, 2020 for a total of 44 preschool children.

A copy of this report was reviewed and provided to the facility. Director agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of their signature once she received the report. LPA requested licensee to email a copy of signed form for records.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian PattersonTELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
LIC809 (FAS) - (06/04)
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