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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290795
Report Date: 03/08/2024
Date Signed: 03/08/2024 03:14:19 PM


Document Has Been Signed on 03/08/2024 03:14 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:YMCA OF METRO LA/SANTA CLARITA VALLEY MEADOWSFACILITY NUMBER:
191290795
ADMINISTRATOR:NATALIE GALSTYANFACILITY TYPE:
840
ADDRESS:25577 FEDALA ROADTELEPHONE:
(310) 486-2870
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:82CENSUS: 25DATE:
03/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Site Supervisor Kyle Mitchell TIME COMPLETED:
03:45 PM
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On Feb 08, 2024, Licensing Program Analyst (LPA) Andrew Alemoh conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 02/11/24; this incident was reported timely. LPA were greeted by Site Supervisor Kyle Mitchell who guided LPA on a tour of the facility. Upon arrival, there were 25 children and 5 staff present today.

Description of incident:
On 02/11/2024 The incident report indicated that Child #1 who is enrolled in the school age program. Child #1 was playing catch with a group of children with a foam ball. C1 caught the ball in a unusual way causing his left pinky finger to hurt after the catch. C1 went to show SS(site supervisor) his pinky finger. SS observed C1 pinky finger and appeared that there was no bruising, or swelling. SS asked if C1 can bend his pinky finger and C1 showed SS that he was able to bend his pinky finger as well as open and close his hand. SS asked C1 if he would like some ice pack for his pinky and C1 rejected the ice pack and wanted to continue playing. SS asked C1 if he would like to take a break and C1 rejected and wanted to continue playing. SS checked on C1 pinky finger a few moments later and there still was no signs of injury.

Staff handled the situation accordingly by trying to initiate first aid and immediately contacting child #1’s parents. During the inspection, LPA interviewed staff, site supervisor and children and observed were the incident occurred. During the time of interviews it was determined that the incident that occurred was an accident.

The information obtained during the unusual incident follow up revealed no violations were found. Facility is encouraged to continue to report incidents that occur in the facility.

An exit interview was conducted, a copy of this report was provided along with the notice of site visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024
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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