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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401223
Report Date: 10/27/2020
Date Signed: 10/27/2020 04:31:10 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./HARDING SITEFACILITY NUMBER:
197401223
ADMINISTRATOR:VERONICA ESPINOZAFACILITY TYPE:
840
ADDRESS:13060 HARDING STREET, #28TELEPHONE:
(818) 838-4653
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:70CENSUS: 22DATE:
10/27/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:VERONICA ESPINOZATIME COMPLETED:
04:15 PM
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On 10/27/2020 Licensing Program Analyst (LPA) Loyce Phillips conducted a Case Management- Incident inspection to follow up on an Unusual Incident reported to the department by telephone on 8/18/2020; this incident was reported timely. LPA spoke with Site Director, Veronica Espinoza Due to COVID-19 Emergency Response this inspection was conducted Tele-Visit. LPA virtually toured the facility and took a census of the children. Upon arrival, there were 22 children and 3 staff present today at the facility.

Description of the incident: On 8/17/2020 at 2:15 child 1 was playing in the gym, while running child 1 snagged his left pinky on his pants pocket. Staff 1 immediately gave child 1 an ice pack. Site Director called parent to inform her of the incident right away. Parent arrived at the regular time to pick child 1 up. The parent took child 1 to the doctor. The doctor stated child 1 had a small fracture on his pinky finger.

Based on the information provided and interviews conducted, the incident appears to have been a self-inflicted accident and no Title 22 violations have occurred; therefore, no deficiencies cited. An exit interview was conducted, and a copy of this report was read and provided to the Site Director, Veronica Espinoza.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020
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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