191220762-3-3-2022-30-CC-DLOE-CC72CP-20220303161705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191220762
Report Date: 03/03/2022
Date Signed: 03/03/2022 04:17:11 PM

Document Has Been Signed on 03/03/2022 04:17 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	YMCA OF METRO L.A./MID VALLEY CHANDLER		FACILITY NUMBER:	191220762
ADMINISTRATOR:	MARILYN RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	14030 WEDDINGTON		TELEPHONE:	(818) 906-1923
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91401
CAPACITY:	70	CENSUS: 18	DATE:	03/03/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	02:47 PM
MET WITH:	Marilyn Rodriguez		TIME COMPLETED:	04:20 PM

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On 03/03/2022 at 2:47 pm, Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Case Management – COVID-19 inspection for the purpose of following up on 2 Unusual Incident Reports (UIR) submitted on 01/19/2022. LPA Lowe met with Director, Marilyn Rodriguez. YMCA program is located on Chandler Elementary school campus. YMCA program entrance is located on Hazeltine Ave in a modular building with 2 adjoining rooms. LPA Lowe toured the classrooms and outdoor area.

LPA observed 18 school age children in care with 2 staff. Staff present were observed to have their criminal record clearances.

According to the UIR, on 01/19/2022 – 2 children were reported as testing positive for COVID-19.

According to the 2^nd UIR, on 01/19/2022 – 1 child was reported as testing positive for COVID-19.

Director stated all of the children who were reported positive COVID have all isolated and have since all returned to the facility. LPA Lowe observed the children who were reported with positive COVID to be in attendance during visit.

During visit LPA Lowe observed the children and staff wearing masks. Classrooms were observed to have a supply of masks. Classrooms were observed with hand sanitizer available in each room. Sinks were not observed in classrooms. Director stated once children are done with the school day they meet YMCA staff by the lunch area, all children are directed to use restroom and wash hands before walking as a group to the YMCA classrooms. LPA observed designated school bathrooms to have soap and air dryers available for children to wash their hands.

LPA observed a table just inside of classroom door with a box of masks, hand sanitizer, and binder labeled visitors log. Children sign in/out sheets were observed on the wall next to table in individual file folders, one for each child. LPA Lowe observed sign in/out sheets to have staff signature for sign in and parent/

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A./MID VALLEY CHANDLER	FACILITY NUMBER: 191220762
	VISIT DATE: 03/03/2022

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guardians’ full signature for pick up.

LPA Lowe observed COVID-19 signage within both classrooms. At the entrance door to the facility LPA observed a sign on the door advising mask wearing no matter vaccination status. In facility LPA observed signs for mask wearing, six feet apart from others, stay home if sick, and self-screening with COVID symptoms. Director stated they conduct observational wellness checks on children. LPA Lowe reviewed daily wellness check log.

LPA Lowe observed facility supply of PPE COVID supplies as gloves, hand sanitizing wipes, masks, thermometer, and cleaning wipes. Director stated additional PPE supplies are available in the elementary school office.

LPA Lowe discussed with Director current COVID-19 resources and guidance.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted and a copy of this report (LIC 809), appeal rights, and Notice of Site Visit were provided to Director, Marilyn Rodriguez.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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