Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212190
Report Date: 10/27/2017
Date Signed 10/27/2017 03:50:58 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: 9DATE:
10/27/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Marge CastellanoTIME COMPLETED:
04:09 PM
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Licensing Program Analyst(LPA) Mingle made an unannounced visit to this after school program in order to conduct an Annual/random review and met with the site director, Ms. Karla Gutierrez. The purpose of the visit was discussed and tour of the facility was conducted. The facility uses one classroom for the after-school program.
The classroom was toured and found free of hazards.

Drinking water was available indoors and out for the children in care. Outdoor activity space was free of hazards. The center share the playground with the elementary school. Bathrooms were located outside with demarcated for boys and girls.

Children files reviewed had emergency identification and notification of parents rights. Staff file reviewed contained immunization requirements for S1 that met SB792 (Mendoza) requirement.. S2 and S3 stated they have completed immunization but there were no copies for review. Ms. Gutierrez was informed to submit proof of immunization for S2 and S3 to the Department by close of business Monday. Sign in/out sheet had full signature and time. Staff had CPR/First aid certification with an expiration of 6/6/2019. Ms. Gutierrez stated that there were no children on prescribed medication currently.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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: 10/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2017
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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