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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214910
Report Date: 08/20/2019
Date Signed: 08/20/2019 12:21:53 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:MONTECITO BRANCH-CHANNEL ISLANDS YMCAFACILITY NUMBER:
426214910
ADMINISTRATOR:ANNE R. FISCHERFACILITY TYPE:
840
ADDRESS:385 SAN YSIDRO ROADTELEPHONE:
(805) 969-3249
CITY:SANTA BARBARA, CASTATE: CAZIP CODE:
93108
CAPACITY:36CENSUS: 0DATE:
08/20/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Ben OlerTIME COMPLETED:
12:30 PM
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A case management inspection was conducted by LPA S. Mendoza-Ceja and C. Patterson who met with Site Director Ben Oler regarding a change of classrooms. The after school program is located at Montecito Union Elementary School and will operate in classrooms #18 and #19. The classrooms were inspected, including the outside playground areas. LPAs observed tables and chairs available in the classrooms. LPAs also observed a carbon monoxide detector. Staff records were not available for review. LPA discussed the requirement of AB 1207 Child Mandated Reporter Training for staff. LPA also reviewed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised, each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or obtain a sign statement declining the influenza vaccination. Also reviewed were the handouts“Effects of Lead Exposure, Child Care Provider’s Guide to Safe Sleep, and Safe Sleep in Child Care"

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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


Prior to licensure the following will need to be completed:
1. Submit verification the appropriate documents are posted.
2. Submit a sketch of the overall school and indicate areas to be used by children.
3. Obtain the Fire Clearance for use of classroom #18 and #19.


The Notice of Site Visit was posted at the visit.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019
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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