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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220762
Report Date: 09/17/2024
Date Signed: 10/23/2024 09:22:18 AM


Document Has Been Signed on 10/23/2024 09:22 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:YMCA OF METRO LA/MID VALLEY CHANDLERFACILITY NUMBER:
191220762
ADMINISTRATOR:MARILYN RODRIGUEZFACILITY TYPE:
850
ADDRESS:14030 WEDDINGTONTELEPHONE:
(310) 486-6748
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:70CENSUS: 39DATE:
09/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Daisy OrdonezTIME COMPLETED:
03:30 PM
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On 9/17/2024, Licensing Program Analysts (LPAs) Suzette Ornelas and Dawn Dowling conducted a case management visit at facility mentioned above for the purpose of investigating the incident that occurred at the facility on 9/11/2024. LPAs met with Lead Teacher, Daisy Ordonez and observed 4 staff supervising 36 children.

The Department received the Unusual Incident Report via phone call on 9/13/2024. According to the report, at approximately 3:15PM in the outside yard, a student smashed their front two knuckles on a cement bench. Staff 1 (S1) stated that Child 1 (C1) lifted the bench and Child 2 (C2) put their fingers underneath the part of the bench that was lifted. There was 1 staff member present supervising 14 children.

During todays visit, LPAs made observations, interviewed staff and children and took pictures of where the incident took place. According to S1 children were being supervised and were meeting ratio requirements. S1 stated they did not see the incident occur but were within the visual range looking in the opposite direction to ensure all children were being supervised. S1 further stated that they heard C2 cry, S1 then went over to comfort C2 and administer first aid.

According to C1, C1 stated that someone told them to "pick it up" so when C1 picked the bench up, C2 put their fingers underneath the part of the bench that was loose and able to be lifted. C1 further stated that C2 finger was stuck and they pulled it out from underneath the loose part of the bench themselves. C2 stated that C1 and C3 picked up the bench and their finger got stuck while they were walking with their hand out. C3 stated that C1 lifted the bench.

At this time there are no deficiencies found so no citations will be given.
A technical Violation will be given to ensure that the bench is repaired a soon as possible on or before to ensure that no further injuries occur.
Exit interview was conducted and Notice of Site Visit was provided to the Lead Teacher, Daisy Ordonez.
SUPERVISOR'S NAME: Raul NavarroTELEPHONE: (424) -30-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024
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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