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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212190
Report Date: 10/09/2020
Date Signed: 10/09/2020 11:22:11 AM

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:CAMARILLO BRANCH - CAMARILLO FAMILY YMCAFACILITY NUMBER:
566212190
ADMINISTRATOR:MARGE CASTELLANOFACILITY TYPE:
840
ADDRESS:3111 VILLAGE AT THE PARK DR.TELEPHONE:
(805) 484-0423
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:30CENSUS: 24DATE:
10/09/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Paige HarrisTIME COMPLETED:
11:03 AM
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On October 09, 2020 at 9:25 AM, Licensing Program Analysts (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA met with Director Paige Harris and discussed the nature and purpose of the inspection. The tele-inspection was conducted via Facetime. During this tele-inspection the applicant took LPA on a tour of the facility. Licensee had 24 children in care at the time of the inspection.

Licensee submitted application to the Community Care Licensing requesting to increase their capacity and add a second studio room at the childcare center. The facility uses the gym, outdoor blacktop, and one studio. Currently the facility has a waiver regarding their swimming pool. On September 9, 2020 the Ventura County Fire Department inspector conducted a fire inspection. The facility received a fire clearance approval for the second classroom. The second studio room is normally an exempt room the facility gym utilizes for gym members to have care for their children when using the gym. Due to COVID-19 the gym’s exempt children room is closed until further notice. The studio has one private restroom with one toilet and sink. Director was informed that once the facility gym resumes operations to provide exempt care for gym members, the licensed room will no longer be authorized to provide care for children under their license. Director advised they must contact Community Care Licensing and inform them that the gym is resuming normal operations. An updated application must be submitted. Facility’s current capacity is 30 and are requesting to increase to 44 children.

Studio indoor 726 square feet meets the requirement for 14 children.
Indoor Gymnasium meets the requirement for 30 children.

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SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CAMARILLO BRANCH - CAMARILLO FAMILY YMCA
FACILITY NUMBER: 566212190
VISIT DATE: 10/09/2020
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Three sinks which meets the requirement for 44 children.
Three toilets which meets the requirement for 44 children.
Outdoor black top which meets the requirement for 44 children.

Facility license capacity increase is effective today, October 9, 2020 for a capacity of 44 children.

A copy of this report was reviewed and provided to Director Harris. Director agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of their signature once she received the report. LPA requested Director to email a copy of signed documents for records.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020
LIC809 (FAS) - (06/04)
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