<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212190
Report Date: 08/25/2022
Date Signed: 08/25/2022 04:42:03 PM


Document Has Been Signed on 08/25/2022 04:42 PM - It Cannot Be Edited

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: 18DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Paige Harris TIME COMPLETED:
04:56 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
 On 8/25/2022 at 3:00 PM, Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with site supervisor Paige Harris and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 18 children in care and 3 staff at the time of the inspection.

LPA observed required licensing documents mounted on the walls in the gym. LPA observed the center menu schedule which the facility provides only afternoon snack. Fire drill was last conducted on 6/9/22. The center uses Gym and two studios for children in care LPA observed 3 restrooms available for children in care. LPA did not observe any hazards/toxins items accessible to children in care. There are no guns/weapons or ammunition at the facility. LPA observed a swimming pool on the premises of the facility which is gated and is inaccessible to children in care. Site supervisor states that the day care does not use the swimming pool. Each of the studio rooms have age-appropriate furniture readily accessible for children. The outdoor playground has ample amount of space for children to play.. LPA observed rubber padding under the play structure to help protect the children when they fall. LPA observed an outdoor blacktop that is used for children in care. LPA observed a shed outside on the blacktop, which was locked, site supervisor stated that the shed contains balls and arts and craft supplies. Facility provides water, and the children have water bottles with their names on it for use. Carbon monoxide detector are good and in working condition.



A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility does not have children that require Incidental Medical services (IMS). LPA observed staff files to be complete and current. LPA observed staff members present have a current and valid mandated reporter training certificate and a current CPR/first aid training certificate. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. LPA spoke with site supervisor about new Covid-19 guidelines.

Cont 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: 08/25/2022
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
26
27
28
29
30
31
32
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 follow 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

PIN 22-06-CCP: Lead Testing in Child Care Centers – Frequently Asked Questions and Information on Lead Toxicity Prevention and Water Testing Information was discussed to site supervisor Paige Harris


Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

"No deficiency was cited in todays visit."

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with site supervisor Paige Harris

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2