192006429-3-15-2023-58-CC-DLOE-CPY2PE-20230315173414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192006429
Report Date: 03/15/2023
Date Signed: 03/15/2023 05:34:26 PM

Document Has Been Signed on 03/15/2023 05:34 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	YMCA OF METRO LA/NORTH VALLEY SUPERIOR		FACILITY NUMBER:	192006429
ADMINISTRATOR:	ELIZABETH MOISA		FACILITY TYPE:	840
ADDRESS:	9756 OSO STREET		TELEPHONE:	(818) 426-5034
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	32	CENSUS: 20	DATE:	03/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Amanda Mendoza & Karen Sandoval		TIME COMPLETED:	05:45 PM

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On 03/15/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Annual Required Inspection and met with Facility Representative Amanda Mendoza. LPA toured the facility indoors and outdoors and a census was taken; 20 children under care and supervision of 2 staff members.

YMCA of Metro LA Program Director, Karen Sandoval arrived and continued visit with LPA Lowe.

Facility is located at Superior Elementary School. Upon arrival LPA Lowe observed the children at the lunch benches with the staff supervising the lunch benches and the bathrooms.

LPA observed one school age classrooms, Room 25 is used by YMCA. Days and hours of operation are Monday, Wednesday, Thursday, and Friday 2:23 pm to 6:30 pm. Tuesdays 1:23 pm to 6:30 pm.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Tables and chairs meet the needs of the children in care. LPA Lowe observed a carbon monoxide detector located in the classroom behind the teacher’s desk, LPA was able to hear a successful test of the carbon monoxide detector.

Outdoor area was observed to be located on the black top between room 25 and lunch benches and the grass area. Outdoor area was observed to be free of hazards.

Facility is located on a Los Angeles Unified School District campus; pest control is provided by LAUSD. LPA observed the facility to be free of flies, insects and rodents.

At 3:11 pm LPA Lowe observed two bottles of cleaning chemicals in a cabinet located under the handwashing sink. The cabinet under the handwashing sink was observed with no locks making cleaning chemicals accessible to children in care. No children were in the room at the time of observation. Upon entering the room the facility representative removed the cleaning chemicals during visit and made them inaccessible to children in care by placing them in a child proof locked cabinet labeled as “Cleaning Supplies”. Cleaning chemicals observed were Fabuloso Mulit-Use Cleaner and Oxivir Tb.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY SUPERIOR	FACILITY NUMBER: 192006429
	VISIT DATE: 03/15/2023

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LPA advised per CC Regulation 101238(g) Buildings and Grounds (g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Facility will receive a type B citation for this deficiency. LPA advised a best practice is for staff to walk the room and look for hazards before the children are released from school.

Bathrooms were observed located near the lunch benches. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

Facility does not have access to a kitchen. Facility provides afternoon snacks. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair.

Drinking water is available both indoors and outdoors with use of water fountain and the use of a brita water filter container.

Facility has conducted water lead testing to comply with Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

LPA Lowe observed the following postings on the parent board: Facility License, LIC 613A (9/96), the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems, and a contingency plan for action during fires, floods and earthquakes. Menu was observed posted on the refrigerator.

LPA reviewed a sample of children’s files and observed files to be complete. YMCA uses an electronic document system. A printed copy of all electronic files was available for view.

Review of staff files show staff files to be complete with mandated reporter, immunization verification of Tdap, MMR, and flu, and health screening.

Review of facility file shows Amanda has CPR/First Aid completed on 03/12/2022 and has Preventive Health Practices with nutrition and lead components.

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SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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/NORTH VALLEY SUPERIOR	FACILITY NUMBER: 192006429
	VISIT DATE: 03/15/2023

NARRATIVE

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The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA observed sign out sheets with a section for parent/ guardian to sign out using a full legal signature.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA and facility representative discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and appeal rights and this report was reviewed with Program Director, Karen Sandoval.

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SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 03/15/2023 05:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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/NORTH VALLEY SUPERIOR	FACILITY NUMBER: 192006429
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in two bottles of cleaning chemicals, one bottle of Fabuloso Mulit-Use Cleaner and one bottle of Oxivir Tb were observed in an unlocked cabinet under the handwashing sink accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2023
	Plan of Correction
1 2 3 4	During visit LPA Lowe observed facility representative removed the cleaning chemicals during visit and made them inaccessible to children in care by placing them in a child proof locked cabinet labeled as “Cleaning Supplies”.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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