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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215202
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:45:31 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/23/2024 02:45 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:SIMI VALLEY FAMILY YMCA - JUSTIN EARLY LEARNINGFACILITY NUMBER:
566215202
ADMINISTRATOR/
DIRECTOR:		JAMIE GONZALEZFACILITY TYPE:
850
ADDRESS:2245 N. JUSTIN AVE.TELEPHONE:
(805) 583-5338
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 9DATE:
10/23/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Michelle YainkTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 10/23/24, at 12:50 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Three Year Required inspection of the abovementioned Child Care Center (CCC). LPA met with Michelle Yaink, Director of the CCC. LPA explained the purpose and nature of the inspection to Director. LPA toured the interior and exterior of the CCC. The facility is located on the grounds of the Justin Early Learning Academy in a module classroom. The Preschool operates Monday – Friday 2:20 PM- 6:00 PM. The CCC's hours of operation are modified from 1:10 PM- 6:00 PM when the academy releases students at 1:10 PM. The module classroom is subdivided into two rooms. At the time of inspection, LPA observed 9 children on site, along a teacher. The CCC's Director is assisting with the care and supervision of children on site.

LPA observed required licensing forms and documents posted near the entry door of the CCC. The CCC has a schedule of activities posted on the room wall, along with a menu.. The CCC uses an electronic Sign In/Out system (Daxko) for children and parents. LPA reviewed system entries and observed the arrival and departure times of children in care and well as the electronic signatures of the children's authorized representatives. Disinfectants, cleaning solutions, sharps and medications are located in a locked cabinets within the classroom which are inaccessible to children in care. LPA observed First Aid kits on site. The CCC has ample cubbies for children in care to store their personnel items. The classroom has age appropriate equipment and furnishings available to children in care. The CCC's carbon monoxide detector was tested at 1:22 PM and found to be operable. The CCC a total of four restrooms for children in care. All restrooms observed are in sanitary operating condition. The CCC shares the restrooms with other children in the Justin Early Learning Academy. CCC children are monitored by CCC staff when using the restrooms. LPA observed a refrigerator in the classroom which contained food for the children. The CCC provides an afternoon snacks to children in care. Lunch is not provided to children in care at the CCC. The CCC has supplemental food on site in the event additional food is needed. The CCC also has available bottled drinking water for children inside and outside of the facility. CCCs constructed (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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 3
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: SIMI VALLEY FAMILY YMCA - JUSTIN EARLY LEARNING
FACILITY NUMBER: 566215202
VISIT DATE: 10/23/2024
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before 1/1/20, to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years after the date of the first test. For child care center licenses issued after 7/1/22, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

The CCC outdoor playground areas are enclosed within Justin Early Learning Academy's fencing. The fence’s entry/exit gates are secured. The surfaces of the outdoor playground areas are varied. LPA observed age appropriate play equipment in the play areas. LPA observed a shed in the outdoor area which contains CCC's supplies. LPA observed age appropriate play equipment in the play areas. The play equipment is free of sharp, loose or pointed objects. The play structures in the outdoor playground areas have adequate cushioning materials to absorb falls and shade created by building overhangs and shade sails. Children also use a grassy yard area inform of the classroom. LPA observed no bodies of water on site.

A sampling of staff and children records were reviewed. The children’s records were complete and found to contain emergency contact information, receipts of Parents Rights, among other required licensing documentation and forms. Staff records were reviewed. Staff records sampled were complete and found to contain First Aid/CPR certifications (EMSA approved) and Mandated Reporter Training certification, among other required licensing documentation and forms. LPA notes the last disaster drill at the facility occurred on 10/10/24. Director informed LPA no firearms or ammunition are stored on site.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance (CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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: SIMI VALLEY FAMILY YMCA - JUSTIN EARLY LEARNING
FACILITY NUMBER: 566215202
VISIT DATE: 10/23/2024
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of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility representative was reminded that all adults 18 and over, including employees and volunteers,
as specified in HSC section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website;a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Michelle Yaink.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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