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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501150
Report Date: 04/01/2025
Date Signed: 04/01/2025 04:24:12 PM

Document Has Been Signed on 04/01/2025 04:24 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WHITTIER YMCA SCHOOL AGE SITEFACILITY NUMBER:
191501150
ADMINISTRATOR/
DIRECTOR:		SUSETTE SEPULVEDAFACILITY TYPE:
840
ADDRESS:12510 E. HADLEY ST.TELEPHONE:
(562) 306-5989
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY: 105TOTAL ENROLLED CHILDREN: 53CENSUS: 30DATE:
04/01/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Director, Hend BoulosTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 4/1/25 Licensing Program Analysts (LPAs) Lilli Babcock and Diana Ortiz conducted an unannounced annual inspection. A Covid risk assessment was conducted. LPAs met with Director, Hend Boulos to whom the reason for the visit was explained. Director guided LPAs on a tour of the facility. This is an school age program which is currently licensed for a capacity of 105 children and operates Monday – Friday from 6:30 AM – 6:30 PM. Per Director there are 53 children enrolled.
Census was taken. LPAs observed 30 children with 3 staff present upon arrival. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. LPAs confirmed all individuals present have obtained a criminal record clearance. All children were observed by LPAs to be under supervision, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license.

All areas identified on the Facility Sketch were inspected and the following was observed: There are two classrooms for the school age license. The classrooms were inspected to ensure that furniture and equipment are age-appropriate and in good repair, and the floors have a surface that is safe and clean. Children bring water bottles from home and are allowed to drink freely at any time. Water bottles are refilled as needed by a water jug in the classrooms.

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Brandi VanOostenTELEPHONE: (323) 981-3439
Lilli BabcockTELEPHONE: (323) 981-3350
DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER YMCA SCHOOL AGE SITE
FACILITY NUMBER: 191501150
VISIT DATE: 04/01/2025
NARRATIVE
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LPAs observed materials for children in the classroom. Age-appropriate sinks and toilets were inspected for availability and good repair in the restroom used by children. Per Director, the office is used as an isolation area. Per Director, staff provide 100% supervision when ill child is using the isolation room and/or restroom, and parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Menus for the past 30 days are available upon request. The facility provides breakfast and PM snack. All kitchen, food preparation, and food storage areas are clean, free of litter, rubbish, rodents, and other vermin. All food is protected from contamination, and LPAs inspected that any contaminated food is discarded immediately. LPAs inspected food to be in good quantity and quality.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children were inaccessible to children. Director states that there are no poisons, weapons, or firearms on the premises. A first aid kit was located in both classrooms.

Telephone service, heating, lighting and ventilation were evaluated. LPAs observed the facility to have an operable carbon monoxide detector that meets the standards established in Chapter 8 of Part 2 of Division 12. Fire extinguishers have a service tag date of 7/1/24.

The facility uses the facility gym for recreation.



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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER YMCA SCHOOL AGE SITE
FACILITY NUMBER: 191501150
VISIT DATE: 04/01/2025
NARRATIVE
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Per Director, children bring their water bottles to the gym and are refilled as needed with a water filtration system on the wall. The facility also has an indoor swimming pool on the premises. LPAs observed four entrances to the swimming pool. All entrances are locked with a key lock. The main entrance to the pool in the lobby also has an alarm on the door, which LPAs observed to be operable on this day. The other entrances have a second feature of additional doors which prevent children from entering the pool area unattended. LPAs also observed a life ring with a 23 inch exterior diameter. The life ring is labeled as approved by the United States Coast Guard. A rescue pole with a body hook of more than 12 feet was also observed on the pool deck.

Sign-in and Sign-out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPAs reviewed Disaster Drill log. Last drill was conducted on 3/25/25. LPAs observed all required posted forms to be posted in the front office.

Staff Records and Children’s Records reviewed by LPAs.

Children’s files reviewed contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.


At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER YMCA SCHOOL AGE SITE
FACILITY NUMBER: 191501150
VISIT DATE: 04/01/2025
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any
questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). PIN 21-21.1-CCP. PIN 22-05-CCP

LPAs discussed the safe sleep regulations with licensee facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER YMCA SCHOOL AGE SITE
FACILITY NUMBER: 191501150
VISIT DATE: 04/01/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Hend Boulos.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC809 (FAS) - (06/04)
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