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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213111
Report Date: 09/28/2022
Date Signed: 09/28/2022 05:14:45 PM


Document Has Been Signed on 09/28/2022 05:14 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:CONEJO VALLEY YMCA - MATES SITEFACILITY NUMBER:
566213111
ADMINISTRATOR:JAMIE GONZALEZFACILITY TYPE:
840
ADDRESS:2000 LA GRANADA DRTELEPHONE:
(805) 630-8477
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:87CENSUS: 51DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Giselle LopezTIME COMPLETED:
05:30 PM
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On 9/28/2022 at 2:45 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 Assistant Director Giselle Lopez and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 51 children in care and 6 staff at the time of the inspection.

LPA observed required licensing documents mounted on the walls throughout the facility. LPA observed the center menu schedule which the facility provides afternoon snack. Fire drill was last conducted on 4/22/22. The center has two (2) classrooms available. At the time of inspection, all 2 classrooms were in use. LPA observed enough 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 no bodies of water. Each of the classrooms have age-appropriate toys and furniture readily accessible for children.The outdoor playground has ample amount of space for children to play. LPA observed facility uses outdoor blacktop and school field that is used for children in care The outdoor play area has an ample amount of shade available. Facility provides water, and the children have water bottles with their names on it for use.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility has children that require Incidental Medical services (IMS). LPA observed medications locked and stored out of reach from children. LPA observed staff files to be complete and current. LPA also observed all staff members with a current and valid Mandated reporter training and Valid CPR/first aid. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. LPA spoke with assistant director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines.

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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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