434413059-10-24-2019-07-CC-SYIP-BH9U53-20191024151600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413059
Report Date: 10/24/2019
Date Signed: 10/24/2019 03:16:06 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 @ JACKSON OAKS ELEMENTARY		FACILITY NUMBER:	434413059
ADMINISTRATOR:	MARIA BETANCOURT		FACILITY TYPE:	840
ADDRESS:	2700 FOUNTAIN OAKS DR ROOM10		TELEPHONE:	(408) 972-5132
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	50	CENSUS: 23	DATE:	10/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Maria Betancourt		TIME COMPLETED:	03:25 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 Analyst (LPA) Samantha Yip conducted an unannounced annual random inspection. LPA met with Site Director Maria Betancourt and explained the reason for the inspection. Present during the inspection were 23 children and 3 staff. The teacher child ratio was observed to be in compliance during today's inspection. Facility is located on Jackson Oaks Elementary School campus. Facility currently uses Room 10, cafeteria, and the library. License, Emergency Disaster Plan, and Notification of Parent's Right were observed to be posted. LPA toured the inside and outside of the facility. The facility was observed to be clean. Furniture and equipment, such as tables and chairs, were observed to be age appropriate and in good condition. There is sufficient amount of toys for children in care. Disinfectants, cleaning supplies, and other items that are dangerous to children in care were observed be stored inaccessible to children in care. LPA reminded to place disinfectant wipes, such as Clorax wipes, inaccessible to children. Site Director stated that there are no weapons, such as firearms, stored on the premise. LPA observed a fully charged fire extinguisher and smoke detector. Facility uses the playground and blacktop on campus. Outside activity area is fenced. Shaded rest area is provided through trees. There were no bodies of water during today's inspection. Facility does provide snacks to the children in care. Menu was observed to be posted. Drinking water is provided water fountains and Brita. ----------------continues on 809 dated 10/24/2019 page 1-------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

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

FACILITY NAME: YMCA @ JACKSON OAKS ELEMENTARY	FACILITY NUMBER: 434413059
	VISIT DATE: 10/24/2019

NARRATIVE

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-------------------continuation of 809 dated 10/24/2019 page 1-----------------------------------
A copy of the facility roster was obtained. 10 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and parent's rights.

2 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credits and Mandated Reporter Training. LPA reminded Site Director that Mandated Reporter Training requires renewal every 2 years. Site Director stated that they have completed CPR/1st Aid training the week of 10/13/2019. Site Director stated that they are still waiting for their CPR/1st Aid cards to come in.

Staff present during the inspection have cleared criminal record and child abuse index clearanc. LPA also remeinded 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 Director stated that she currently does have children in care who requires Incidental Medical Services (IMS) services. Medication is properly stored where it is out of the reach of children and with the proper documents. LPA reminded Site Director to check expiration dates of medication. 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.

Site 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 Director. 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: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

LIC809 (FAS) - (06/04)

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