566213111-1-13-2021-17-CC-MMDS-BX949K-20210113175427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566213111
Report Date: 01/13/2021
Date Signed: 01/13/2021 05:55:35 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:	CONEJO VALLEY YMCA - MATES SITE		FACILITY NUMBER:	566213111
ADMINISTRATOR:	LEONA SANDOVAL		FACILITY TYPE:	840
ADDRESS:	2000 LA GRANADA DR		TELEPHONE:	(805) 630-8477
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	75	CENSUS: 0	DATE:	01/13/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Katie Oberman		TIME COMPLETED:	03:15 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 January 13th, 2021, at 2:00 pm Licensing Program Analyst (LPA) M. McDaniels and LPA Francisco Pedroza conducted a Tele - Case Management inspection and met with Site Supervisor, Ms. Katie Oberman. LPAs advised Site Supervisor the purpose of the inspection. Due COVID -19 and Department of Public Health guidelines of social distancing a Tele - Inspection was conducted via FaceTime. Site Supervisor provided LPA’s a tour of the facility. There were no children in care at the time of the inspection. The facility applied to Community Care Licensing (CCL) requesting an increase in capacity to 115 children and authorize an additional classroom to use for care and promote social distancing. The facility received an approved fire clearance from Ventura County Fire Department on December 03, 2020. The facility will be using two classrooms and the multipurpose room for care. The two classrooms and multipurpose room were inspected today and found to be free hazards. Previously the facility had a third classroom authorized to use for care. Site Supervisor was advised to follow-up with the school and get written advise if they are still authorized to use the third classroom. LPA’s observed age appropriate furniture and equipment for children. The center has a total of 3,061 square feet available for children in care with the two classrooms and multipurpose room. The center meets Title 22 Division 12 requirements.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria McDaniels	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

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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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: CONEJO VALLEY YMCA - MATES SITE	FACILITY NUMBER: 566213111
	VISIT DATE: 01/13/2021

NARRATIVE

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License will be effective today, January 13,2021 for 87 school-age children.

Pending the approval and permission of use of a third classroom that was previously licensed will determine if the facility can increase more than 87 school-age children.

Exit interview was conducted with Ms. Katie Oberman. A copy of this report was reviewed and provided to The Site Supervisor who agreed to receive a copy of the report via email and voiced understanding that the read receipt confirmation from email will be in lieu of her signature once she received the report...

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria McDaniels	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

LIC809 (FAS) - (06/04)

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