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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212190
Report Date: 09/27/2021
Date Signed: 09/27/2021 02:25:12 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: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:44CENSUS: 2DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Paige HarrisTIME COMPLETED:
02:35 PM
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On September 27, 2021 at 1:34 pm, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with facility Director Paige Harris and advised her the purpose of the inspection. Director provided LPA tour of the facility inside and out. There were two children in care at the time of the inspection. Hours of operation 7:00 am to 8:30 am and 12:30 pm to 6:00 pm.

Facility uses the gym, two studio's, and the outdoor blacktop for children in care. LPA observed the facility had the required state documents posted on the wall in the gym. The restrooms were found clean and free of toxins. The classrooms were found free of hazards. Drinking water is available indoors and out. The outdoor playground has age appropriate toys and equipment. The facility has a swimming pool on the premises. The facility has multiple doors with coded a lock on each preventing children in care having access to the pool.

LPA reviewed a sampling of children and staff records. Facility now has all records on a electronic database available when requested. Teachers have required qualifications. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Facility is following current Covid-19 guidelines.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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