426214475-9-24-2019-17-CC-SMCA-BGC26N-20190924170726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426214475
Report Date: 09/24/2019
Date Signed: 09/24/2019 05:07:35 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:	LOMPOC YMCA-MIGUELITO SCHOOL SITE		FACILITY NUMBER:	426214475
ADMINISTRATOR:	STEPHANIE SAUCEDO		FACILITY TYPE:	840
ADDRESS:	1600 WEST OLIVE AVENUE		TELEPHONE:	(805) 757-5038
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	50	CENSUS: 24	DATE:	09/24/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Claudia Ortiz and Stephanie Saucedo		TIME COMPLETED:	05:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Case Management Inspection was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson who met with Claudia Ortiz and Stephanie Saucedo regarding the change of classrooms. The after school program is located on the Miguelito Elementary School. The after school program will begin operating in Classroom #33 and in the Multipurpose Room (MPR). LPAs inspected the Multipurpose Room where the children were in care today and the new classroom #33. During the visit, it was found that Rijo Jackson was live scanned 09/16/2014 and obtained a criminal record clearance with the Department; but is no longer associated to the facility and does not have a criminal record clearance with the Department. Claudia Ortiz and Stephanie Saucedo were advised an immediate civil penalty of $500.00 assessed for allowing an individual to work in the facility without a criminal record clearance. Prior to approval the following areas will need to be completed: 1. Control of Property - Agreement between YMCA and School to utilize Classroom #33 and the Multipurpose Room. 2. Fire Clearance to utilize the Classroom #33 and the Multipurpose Room. 3. All adults working with children shall have a criminal record clearance with the Department.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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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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: LOMPOC YMCA-MIGUELITO SCHOOL SITE	FACILITY NUMBER: 426214475
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/24/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/24/2019 Section Cited	1 2 3 4 5 6 7	101170 (e) Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. (h) Violation of Section 101170(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.
	8 9 10 11 12 13 14	The above regulation was not met as evidenced by the record review and interviews. Review of records revealed Rijo Jackson no longer has a criminal record clearance with the Department or this facility. An immediate civil penalty of $500.00 assessed. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: LOMPOC YMCA-MIGUELITO SCHOOL SITE	FACILITY NUMBER: 426214475
	VISIT DATE: 09/24/2019

NARRATIVE

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The following Type A deficiency is cited on page #3 according to CCR, Title 22 Division 12 Regulations in regards to Criminal Record Clearance. Appeal rights provided.

Upon receipt, post and provide copies of this licensing report: to parents/guardians of children in care at the facility and to parents/guardian of children newly enrolled at the facility during the next 12 months. Licensee shall obtain signatures of parents/guardian on the Acknowledgement of Receipt of Licensing Reports LIC 9224.

The Notice of Site Visit was posted.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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