Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613958
Report Date: 05/18/2016
Date Signed 05/18/2016 05:20:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CENTRAL ORANGE COAST YMCA - LOMA VISTA SCHOOLFACILITY NUMBER:
300613958
ADMINISTRATOR:MEDINA, ELIZABETHFACILITY TYPE:
840
ADDRESS:13822 PROSPECT AVE.TELEPHONE:
(714) 730-0541
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:65CENSUS: 33DATE:
05/18/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Elizabeth Medina - Site SupervisorTIME COMPLETED:
05:30 PM
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  1. Licensing Program Analyst (LPA) Jane Cong-Huyen met with the site director, Elizabeth Medina, for a case management - licensee Initiated visit for an increase of capacity. The facility is currently licensed for 65 children and the facility is now requesting for an increase of capacity to 86 children. Loma Vista Elementary School is planning to allow the YMCA to use one of the classrooms (Rm # B4) as of 6/20/16.

LPA toured the facility and observed 33 children with 5 staff including the site director. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility has a copy of the following documents posted in a conspicuous area: personal rights, menus, emergency disaster plan, earthquake preparedness checklist, parent's rights, and car seat law information.

INDOOR ACTIVITY SPACE:
The room is equipped with appropriate furnishings. There are individual cubbies for storing children's personal belongings. The facility provides snacks to the children in care. LPA observed a complete first aid kit. The facility provides water in every classrooms. There are drinking fountains throughout outdoor area. Smoke alarm, carbon monoxide detector and fire extinguisher met regulations.

There were 2 classrooms (portable building - M3 and classroom B-4) that were measured for the school-age program. The rooms contains a total of 2,756 square feet which will accommodate up to 79 children. (The facility originally requested for 86 children) Currently, the facility has a fire clearance for 84 children but based upon current measurements, the two classrooms can only accommodate up to 79 children. The portable (M-3) can accommodate up to 54 children and the classroom B-4 can accommodate up to 25 children. There are 7 toilets and 7 sinks at the facility. There will be separate bathrooms for the different groups of children according to age groups.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jane Cong-HuyenTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2016
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRAL ORANGE COAST YMCA - LOMA VISTA SCHOOL
FACILITY NUMBER: 300613958
VISIT DATE: 05/18/2016
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(Case Management, page 2)

There separate staff restrooms. Individual measurements are recorded. Children who become ill during the day will be isolated in the front lobby and will use the staff restroom if necessary. The children will be escorted to the staff bathroom.


OUTDOOR ACTIVITY SPACE:
The facility will be using the elementary school main grass area for play yard area that was measured. The outdoor play area is fenced and is equipped with age-appropriate equipment as follows: climbing structures/toy structures, swings and sand area. There is sufficient resilient material underneath climbing structures. There are large umbrellas to provide shade. The outdoor activity space was measured.

There was 1 play yard area that were measured.

Total = 95,000 square feet, sufficient outdoor activity space to support the requested capacity of 79 children at a time.


The facility will be approved for the increase in capacity for a total of 79 school-age children by 5/19/16 but the facility will not be using classroom B-4 until 6/20/16.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jane Cong-HuyenTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2