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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214910
Report Date: 10/14/2019
Date Signed: 10/14/2019 04:45:49 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: 27DATE:
10/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Ben OlerTIME COMPLETED:
05:00 PM
NARRATIVE
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An annual random was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and C. Patterson who met with Ben Oler. The school age program operates on the grounds of Montecito Union Elementary School in in classrooms #18 and #19. LPAs inspected the classrooms and the outside playground area. LPA observed the classrooms to be clean and orderly. LPA observed drinking water available in the classroom and outside available. The restrooms were also inspected. LPA was advised there is no medication being administered at this time. LPA reviewed children's records for emergency contact information and the sign in/out sheets. Staff qualifications were reviewed which includes the completion of the AB 1207 Child Mandated Reporter Training for staff. LPA reviewed current EMSA approved CPR and First Aid for one 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.

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
The Notice of Site Visit was posted at the visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2019
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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