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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561709909
Report Date: 10/13/2022
Date Signed: 10/13/2022 04:36:39 PM

Document Has Been Signed on 10/13/2022 04:36 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:CONEJO VALLEY YMCA PEACH HILL SITEFACILITY NUMBER:
561709909
ADMINISTRATOR:JAMIE GONZALEZFACILITY TYPE:
840
ADDRESS:13400 CHRISTIAN BARRETT DR.TELEPHONE:
(805) 630-8621
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 37DATE:
10/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Alissa WhiteleyTIME COMPLETED:
04:50 PM
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On 10/13/2022 at 2:20PM, Licensing Program Analysts (LPA) Michael Mathew conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with director Alissa Whiteley and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 37 children in care and 3 staff at the time of the inspection.

LPA observed required licensing documents mounted on the walls throughout the facility. LPA observed the center menu schedule which the facility provides afternoon snack. Fire drill was last conducted on 9/23/22. The center has two (2) classrooms available. At the time of inspection, 2 classrooms were in use. LPA observed enough restrooms available for children in care. LPA did not observe any hazards/toxins items accessible to children in care. There are no guns/weapons or ammunition at the facility. LPA observed no bodies of water. Each of the classrooms have age-appropriate toys and furniture readily accessible for children.The outdoor playground has ample amount of space for children to play. Facility uses school blacktop and field. LPA observed soft rubber padding under the play structure and swing set to help protect the children when they fall. LPA observed the playground has age-appropriate toys and structures available for children to use. LPA observed carbon monoxide detector are good and in working condition. The playground has an ample amount of shade available. Facility provides water, and the children have water bottles with their names on it for use.

A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. Currently the facility does not have children that require Incidental Medical services (IMS). LPA observed staff files to be complete and current. LPA observed all staff members with a current and valid mandated reporter training and a current CPR/first aid certificate. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. LPA spoke with director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines.
Continued 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CONEJO VALLEY YMCA PEACH HILL SITE
FACILITY NUMBER: 561709909
VISIT DATE: 10/13/2022
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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 follow 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

PIN 22-06-CCP: Lead Testing in Child Care Centers – Frequently Asked Questions and Information on Lead Toxicity Prevention and Water Testing Information was discussed to director Alissa Whiteley


Director was reminded that all adults 18 and over, 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.

"No deficiencies were cited in todays visit" .

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with director Alissa Whiteley

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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