Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212190
Report Date: 05/18/2017
Date Signed 05/18/2017 04:27:04 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: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:30CENSUS: 28DATE:
05/18/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:11 PM
MET WITH:Simpson ConnorTIME COMPLETED:
04:42 PM
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Licensing Program Analyst, LPA Mingle made an unannounced visit in order conduct an Annual/Random review and met with the site Supervisor, Ms. Connor Simpson. The purpose of the visit was discussed and a tour of the center was conducted.
The center is located in the YMCA gym in Camarillo and uses the gym as classroom. There is a swimming pool next to the playground which was observed fenced off by a 5 foot wire fence. Classroom toured was free of hazards. Surface of classroom was clean Detergents and leaning supplies are kept in the child watch room. The center has drinking water available.
There were medication on board for 2 children. Medications were observed in a locked box inside a shed at the playground. Furniture and equipment were in good repair. Surface of playground area was free of hazards and maintained. There were separate bathrooms for boys and at the hall way.
All adults present have obtained a Criminal Record Clearance. Current CPR/First aid requirement was verified by review of Staff's certification. Sign in/out sheets were complete with full signature and time.
Children's files reviewed had information of authorized representatives and medical assessments. Snack Menu was observed posted in plain view. Staff present are in compliance with SB792(Mendoza) requirements.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

There were no deficiencies cited for today's visit,.

SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: George MingleTELEPHONE: 805-562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2017
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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