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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220762
Report Date: 11/05/2024
Date Signed: 11/06/2024 08:33:25 AM

Document Has Been Signed on 11/06/2024 08:33 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/
DIRECTOR:
MARILYN RODRIGUEZFACILITY TYPE:
850
ADDRESS:14030 WEDDINGTONTELEPHONE:
(310) 486-6748
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY: 70TOTAL ENROLLED CHILDREN: 45CENSUS: 42DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:58 PM
MET WITH:Daisy OrdonezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 11/5/2024, Licensing Program Analyst (LPA) conducted a case management visit at facility mentioned above for the purpose of investigating the incident that occurred at the facility on 10/15/2024. LPA met with Lead Teacher, Daisy Ordonez and observed 4 staff supervising 42 children.

The Department received the Unusual Incident Report via phone call on 10/16/2024. According to the report, at approximately 3:30PM, Child 1 (C1) reported to staff 1 (S1) that their nose was hurting. C1 further stated that they had placed a bead in their nose. S1 was not able to see the bead and contacted parent regarding the incident. Parent picked up and took C1 to seek medical attention to remove the bead from their nose. C1 was released back to care without restrictions.

During todays visit, LPA made observations, and conducted interviews.
According to C1, they stated that they saw a small black bead by the lunch tables and it was really shiny and really wanted it so they put it inside their nose. C1 further stated that their parent picked them up, took them to the doctor where a stick was used to remove the bead. S1 stated that C1 approached them and informed them that there was a bead in their nose. S1 used a flashlight to confirm that there was something inside and immediately contacted parent who took C1 to the doctor and had bead removed from their nose.

At this time there are no deficiencies found so no citations will be given.

Exit interview was conducted and Notice of Site Visit was provided to the Lead Teacher, Daisy Ordonez.
Raul NavarroTELEPHONE: (424) -30-3072
Suzette OrnelasTELEPHONE: 424-301-3008
DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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