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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215645
Report Date: 09/27/2021
Date Signed: 09/27/2021 03:49:46 PM

Document Has Been Signed on 09/27/2021 03:49 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:CAMARILLO YMCA - PLEASANT VLY. SCH. OF ED. & ARTSFACILITY NUMBER:
566215645
ADMINISTRATOR:PAIGE HARRISFACILITY TYPE:
840
ADDRESS:1605 BURNLEY ST.TELEPHONE:
(805) 484-0423
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Sonia RosalesTIME COMPLETED:
04:05 PM
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On September 27, 2021 at 2:50 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with Site Supervisor Sonia Rosales and advised her the purpose of the inspection. Site Supervisor provided LPA a tour of the facility inside and out. There was 11 children in care at the time of the inspection. Facility hours of operation are 7:00 am to 8:30 am and 12:30 PM to 6:00 PM Monday thru Friday.

LPA observed the required state documents posted on the wall in the classroom. The facility use one classroom, an outdoor recreation yard enclosed with center block wall, and the local park playground. The facility uses the public restrooms on the facility. Staff escort children to the restroom. LPA observed a posted snack schedule. Children are provided one snack. Drinking water is available indoors and out. The outdoor playground has age appropriate toys and equipment.

LPA reviewed a sampling of children and staff records. Facility now has all records on a electronic database available when requested. Teachers have required qualifications. LPA verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Facility is following current Covid-19 guidelines.

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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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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