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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401223
Report Date: 08/29/2019
Date Signed: 08/29/2019 02:17:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:YMCA OF METRO L.A./HARDING SITEFACILITY NUMBER:
197401223
ADMINISTRATOR:VERONICA ESPINOZAFACILITY TYPE:
840
ADDRESS:13060 HARDING STREET, #28TELEPHONE:
(818) 838-4653
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:70CENSUS: 0DATE:
08/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Veronica EspinozaTIME COMPLETED:
02:31 PM
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Licensing Program Analyst's (LPAs) Smith and Thompson-Miller met with Veronica Espinoza, Director, for a Case Management Incident inspection involving an Incident Report dated July 5, 2019. The incident occurred on July 5, 2019.

Description of the incident: Staff #2 witnessed Staff #1 inappropriately handle Child #1.
It is alleged Staff #1 inappropriately handled a child in care. It was determined Staff #1 interceded Child #1 from hitting Child #2 with a block.

Licensing Program Analyst's (LPAs) Smith and Thompson-Miller met with Veronica Espinoza, Director for the purpose of conducting an interview.

An exit interview was conducted and a copy of this report was read and given to Veronica Espinoza.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Suzanne SmithTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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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