434404895-8-22-2019-07-CC-SYIP-BFB2BP-20190822171529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404895
Report Date: 08/22/2019
Date Signed: 08/22/2019 05:15:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	YMCA-BARRET ELEMENTARY		FACILITY NUMBER:	434404895
ADMINISTRATOR:	PATRICIA REYES		FACILITY TYPE:	840
ADDRESS:	895 BARRET AVE		TELEPHONE:	(408) 778-3225
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	60	CENSUS: 12	DATE:	08/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Patricia "Patty" Reyes and Maia Skreen		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	Licensing Program Analysts (LPAs) Samantha Yip, Nancy Rodriguez and Licensing Program Manager (LPM) Tony Studebaker conducted an unannounced annual random inspection. LPAs and LPM met with Site Supervisor Patricia "Patty" Reyes and Program Director Maia Skreen and explained the reason for the inspection. Facility is located on the Barret Elementary School campus. Facility currently uses the YMCA portables. Present during the inspection were 12 school-age children and at least 4 staff present during today's inspection. The teacher child ratio was observed to be in compliance during today's inspection. Facility uses electronic sign in/sign out. License, Emergency Disaster Plan, and Notification of Parent's Right were observed be posted. LPAs and LPM toured in the inside and outside of the facility. The facility was observed to be clean and sanitary. The floors were free of tripping hazard. LPA observed there is sufficient amount of age appropriate toys for the children in care. Disinfectants, cleaning supplies, and other items that are dangerous were observed to be stored inaccessible to children. Furniture and equipment, such as tables and chairs, were observed to be in good condition and age appropriate. LPA observed restroom for children's use. Storage containers have tight-fitted lids. LPA observed a fully charged fire extinguisher, carbon monoxide detector, and smoke detector. Site Supervisor stated there are no weapons stored on the premise. Facility uses blacktop adjacent to the portables. Facility also uses the playground and blacktop on the elementary school. There is resilient material to absorb falls. Outdoor activity space is fenced. Shaded rest area is provided through canopy. LPA did not observe any bodies of water. -------------------continues on 809 dated 08/22/2019 page 2-----------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: YMCA-BARRET ELEMENTARY	FACILITY NUMBER: 434404895
	VISIT DATE: 08/22/2019

NARRATIVE

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------------------continuation of 809 dated 08/22/2019 page 1---------------------------

Facility does provide snacks to the children in care. Drinking water is provided through water cooler and cups.

7 children's file were reviewed during today's inspection. The records reviewed included but not limited to admission agreement and consent for emergency medical treatment. LPM discussed with Program Director Maia Skreen about updating online forms to include consent for emergency medical treatment.

3 staff files were also reviewed during today's inspection. The records included but not limited to education credit. There is currently at least one staff on site with a valid CPR/1st Aid, which expires on 02/2021. LPA reminded Program Director that Mandated Reporter Training needs to be renewed every 2 years.

Staff present during the inspection have cleared criminal record and child abuse index clearance. LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Site Supervisor stated that she currently does not have any children who requires Incidental Medical Services (IMS). For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Program Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report was discussed and provided to Program Director Maia Skreen. A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

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