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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216221
Report Date: 04/05/2022
Date Signed: 04/05/2022 01:08:52 PM

Document Has Been Signed on 04/05/2022 01:08 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:VENTURA FAMILY YMCA-ATLAS ELEM.FACILITY NUMBER:
566216221
ADMINISTRATOR:JULIE O'BRIENFACILITY TYPE:
840
ADDRESS:760 JAZMIN AVETELEPHONE:
(805) 642-2131
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 0DATE:
04/05/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Amy JuewiczTIME COMPLETED:
01:15 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 04/05/2022 @ 10:00 AM a prelicensing inspection was conducted by Licensing Program Analyst (LPA) S. Mendoza-Ceja who met with Executive Director Amy Jurewicz. Applicant has requested licensure for 35 children. The after school program is located on Atlas Elementary School and will be operating Monday - Friday, 11:30AM - 6:00PM. LPA inspected the modular classroom inside and the outside playground, LPA observed the classroom to be clean, orderly, and appropriately furnished for school age children. LPA observed drinking water available inside and outside. The restrooms were also inspected. Medication when accepted will be maintained in a locked box. LPA inspected the classroom and observed there be one toilet and one sink, a drinking fountain, 36 cubbies, tables and chairs. LPA also measured the classroom to be 910 square feet indoors. LPA inspected outdoor playground which exceeds the playground requirement for 35 children, including additional 3 additional restrooms (5 sinks and 7 toilets) available for the school age children. Staff restroom is located near the office.
The YMCA currently utilizes an electronic/online program E Pact to maintain the children's records and the sign in/out system. LPA reviewed the appropriate documents posted for review which includes and not limited to the Snack Menu, Parent Rights, Personal Rights, Earthquake Preparedness Checklist, Emergency Disaster Plan, Lead Exposure Publication, Car Seat Safety, and SIDS. LPA discussed COVID-19 and was advised the center is following the Ventura Public Health Guidelines along with Ventura School District Policy. Director qualifications were reviewed including AB 1207 Child Abuse Mandated Reporter Training, Health Screening, and verification of current with Pediatric CPR and First Aid.

LPA discussed Unusual Incidents and provided the email address: CDSS CCL Unusual Incident Reports DO 17 <UnusualIncidentReportsDO17@dss.ca.gov>.



LPA reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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: VENTURA FAMILY YMCA-ATLAS ELEM.
FACILITY NUMBER: 566216221
VISIT DATE: 04/05/2022
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
Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior to licensure pending verification of control of property for use of the modular classroom to include the capacity approved by the school district.

Exit interview conducted and report was reviewed with the facility representative Amy Jurewicz.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2