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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371293
Report Date: 07/27/2021
Date Signed: 07/27/2021 10:35:11 AM

Document Has Been Signed on 07/27/2021 10:35 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BOYS & GIRLS CLUBS-SKYLARKFACILITY NUMBER:
304371293
ADMINISTRATOR:RAMIREZ, YUMIFACILITY TYPE:
850
ADDRESS:11250 MAC MURRAY STREETTELEPHONE:
(714) 497-7382
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Yumi Ramirez, Division DirectorTIME COMPLETED:
10:35 AM
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An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of adding a room. The facility has requested to add room G51 to their license and is not requesting a change in capacity. The facility is currently licensed for 24 preschool children. LPA Torrence met with Division Director, Yumi Ramirez, who guided analyst on a tour of the facility. Census was taken. There was a total of 10 preschool children present, with five staff supervising. Operations hours are Monday-Friday; 7:00 a.m.-6:00 p.m., serving children ages 2-5 years old. In classrooms: G51, G52, and G53. The facility have waivers to share yard with special need children and a waiver to co-mingle with the entire school during special events.

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.

All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area, located in the site supervisor's office. The facility has two bathrooms, one bathroom will be used as the isolation bathroom for ill children. Medication will be stored in the classroom. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. The facility provide water inside/outside by a filter water dispenser and disposal cups. First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements.

Center provide breakfast and PM snacks and lunch is delivered to the facility by the school district cafeteria.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BOYS & GIRLS CLUBS-SKYLARK
FACILITY NUMBER: 304371293
VISIT DATE: 07/27/2021
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Indoor Activity Space Measurements:
Classroom G51: 28 x 30.09= 842 sqft.
Total= 842 sqft. divided by 35 = 24 children

Total children toilets and sinks:
3 toilets and 1 urinal x 15 = 60 children
6 sinks x 15 = 90 children

Outdoor Activity Space-Previous Measurements:
Total= 67 x 100= 6,700sqft. divided by 75= 89 children

Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment. Adequate shade is provided by Canopies and trees.

Fire clearance approval letter on file and dated 06/14/2021, adding room #G51.

Facility provides Incidental Medical services.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

A new license with the added classroom will be provided to the facility.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
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