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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214475
Report Date: 04/09/2021
Date Signed: 04/12/2021 04:40:38 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 SITEFACILITY NUMBER:
426214475
ADMINISTRATOR:STEPHANIE SAUCEDOFACILITY TYPE:
840
ADDRESS:1600 WEST OLIVE AVENUETELEPHONE:
(805) 757-5038
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:50CENSUS: 0DATE:
04/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Stephanie SaucedoTIME COMPLETED:
11:45 AM
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 Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted a Case Management Inspection in regards to change of classrooms to #28 and #30. The after school program was previously operating in the Multipurpose Room and classroom #33. LPA advised due to COVID -19 and California Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA met with Stephanie Saucedo, Youth Development Director, the pre- screening questions related to COVID-19. Stephanie Saucedo's responses to the pre-screening questions suggest no COVID-19 exposure on site. LPA S. Mendoza-Ceja conducted the tele-inspection via facetime.

LPA was escorted through the classrooms #28 and #30 by the Stephanie Saucedo. The classrooms were observed to appropriately furnished for school age children indoors. LPA observed the appropriate documents posted for review, in addition to the COVID-19 informational posters. The playground area was also inspected. Drinking water is available indoors and outdoors, in addition some of the children provide their own water bottles. LPA also inspected the restrooms designated for the children (COVID-19 information posted).
LPA was advised there are two isolation areas available one in classroom #28 and the isolation tent which designated for the school.

The Fire Clearance was granted 04/07/2021. Licensure effective 04/09/2021.

An exit interview was conducted with Stephanie Saucedo Youth Development Director. This report will be sent to the via email with a read receipt for confirmation of receipt of the email, Licensee shall sign and return via email to LPA S. Mendoza-Ceja.

Licensee shall post the "Notice of Site Visit for 30 days".
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
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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