191290795-11-6-2020-12-CC-CBEL-BV4SNR-20201106130157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290795
Report Date: 10/30/2020
Date Signed: 11/06/2020 01:02:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	YMCA OF METRO L.A./MEADOWS ELEMENTARY		FACILITY NUMBER:	191290795
ADMINISTRATOR:	RUSHMINA NIKOCEVIC		FACILITY TYPE:	840
ADDRESS:	25577 FEDALA ROAD		TELEPHONE:	(661) 254-2214
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	82	CENSUS: 28	DATE:	10/30/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Rebecca Kelly		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/30/2020 at 3:00 pm Licensing Program Analyst (LPA) Deborah Lowe and LPA Lilian Casillas conducted a tele visit inspection via FaceTime due to the COVID-19 pandemic with Rebecca Kelly - Site Director. The purpose of the visit was to assess the unlicensed areas that will be used at YMCA of Metro L.A. Meadows Elementary located at 25577 Fedala Rd, Santa Clarita, CA 91355 as part of the Private Recreation Program waiver. Hours of operation are Monday - Friday 7:00 am to 6:00 pm with a max capacity of 82. Rebecca Kelly guided LPA Lowe and Casillas on a tour of the child care areas, the YMCA building, room 11 and 19 the science room. Check in will take place at the YMCA entrance gate separate from the elementary school gate. Ms. Kelly stated the staff picks the children up from the parents at their cars. Parents pull up at the curb and a staff member goes to the parents car. Ms. Kelly stated they ask the parents COVID-19 screening questions and take temperatures then take the children inside the school. LPA Lowe and LPA Casillas did not observe wellness station due to it was afternoon and items had been put away. Isolation room is located in the YMCA building in the Directors office. Ms. Kelly stated the children are required to wear masks. LPA Lowe and LPA Casillas observed children wearing mask. YMCA licensed building was observed to be set up for social distancing. Rooms 11 and 19, the science rooms, were observed to have chairs, fire extinguisher, smoke detectors, outlet covers, and tables were spaced for social distancing. There are sinks in both classrooms. Room 19 has stools/chairs and outlets on the floor that were equipped with covers. LPA Lowe and LPA Casillas observed the restrooms near room 19, the boys bathroom has 4 stalls,1 urinal, 2 sinks due to social distancing only 2 stalls are available for use. The girl’s bathroom was observed to have 4 stalls and 2

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: YMCA OF METRO L.A./MEADOWS ELEMENTARY	FACILITY NUMBER: 191290795
	VISIT DATE: 10/30/2020

NARRATIVE

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sinks, due to social distancing only 2 stalls and are available for use. Children also use the bathroom one at a time.

Bathroom near room 11 was observed to have 4 stalls and 4 sinks in the girl’s bathroom, due to social distancing only 2 stalls and 2 sinks are available for use. The boys bathroom was observed to have 4 sinks, 3 urinals, and 3 stalls, due to social distancing 2 sinks, 1 urinal, and 2 stalls are available to use. Children use the bathroom one at a time.

Ms. Kelly stated that the elementary school provides free lunch and AM snack to the students and PM snack is provided by YMCA. All children bring their own water bottles. Due to COVID-19 water fountains are not available.

Outdoor play is located on the field - field was observed to have grass.

Ms. Kelly was informed that the Private Recreation Waiver was approved and will be emailed to her. LPA Lowe advised Ms. Kelly to read the terms and conditions of the waiver. The waiver was approved for the use of 7 unlicensed classrooms on the school campus. Ms. Kelly stated at this time they will only use the 2 observed during this visit. LPA Lowe advised for Ms. Kelly to contact Community Care Licensing when she needs to use more rooms than the 2 rooms observed during this visit so another waiver TA visit can be scheduled.

LPA Lowe emailed the approved waiver to Rebecca Kelly, Site Director and Christopher Jefferson, Assistant Vice President, Child Care.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020

LIC809 (FAS) - (06/04)

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