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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403242
Report Date: 11/02/2022
Date Signed: 11/02/2022 03:33:33 PM


Document Has Been Signed on 11/02/2022 03:33 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/WEST VALLEY ROUND MEADOWFACILITY NUMBER:
197403242
ADMINISTRATOR:ANNA BICKNELLFACILITY TYPE:
840
ADDRESS:5151 ROUND MEADOWTELEPHONE:
(818) 466-9602
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY:75CENSUS: 42DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vicky Rubalcava - Assistant DirectorTIME COMPLETED:
04:00 PM
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On 11/02/2022 Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced Annual Required Inspection for the facility. LPA met with Vicky Rubalcava, Assistant Director, and toured the facility indoors and outdoors. The facility operates an after school program off of the Round Meadow Elementary School site in the "YMCA Bungalow"; two classrooms near the school staff parking lot. The program operates from: Monday, Tuesdays, Thursdays, Friday 12:30pm-6:00pm and Wednesday 11:30am-6:00pm.

Center does not operate during the summer break.

Children Sign-In According to the Site Director:
-Children in TK are signed in at dismissal on Monday, Tuesday, Thursday, and Friday at 1:10pm. Wednesday is an early dismissal day and children are signed in at 11:30am.

-Children in Kindergarten are signed in at dismissal on Monday, Tuesday, Thursday, and Friday at 1:10pm. -Wednesday is an early dismissal day and children are signed in at 11:30am.

-Children in 1st through 3rd are signed in at dismissal on Monday, Tuesday, Thursday, and Friday at 2:11pm.
-4th and 5th grade are signed in at dismissal on Monday, Tuesday, Thursday, and Friday at 2:38pm.
-Wednesday is an early dismissal day and children in 1st through 5th are signed in at 12:55pm.

LPA observed all required postings in a prominent area. LPA observed 42 children and 4 adults. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. A walk through of the classroom area was conducted. LPA observed 2 licensed classrooms on the premises. Classroom space was found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. LPA observed 2 empty storage cabinets in each classroom and 4 boxes of new storage cabinets against the wall in classroom 1.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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/WEST VALLEY ROUND MEADOW
FACILITY NUMBER: 197403242
VISIT DATE: 11/02/2022
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Per assistant director, they are awaiting the removal of the old storage cabinets to proceed with installing new storage in both classrooms. LPA informed assistant director that a picture would need to be send via email to LPA once removal and installment has taken place. There is adequate heating, lighting and ventilation. Drinking water is readily available in each classroom. LPA observed classroom space to have arts/crafts, reading, individual cubbies for storage and learning activities. There is a first aid kit in in classroom 1 underneath the teachers desk . LPA observed adequate arrangements for isolation and care of ill children located in Room 1.

The restroom and toileting areas were inspected. Room 1 and Room 2 share a restroom located outside in the play yard by the lunch tables consisting of 2 toilets and 1 sink. LPA observed toilets and sinks to accommodate the facility’s capacity. Toilets flush properly, toilet and sinks are reachable by the children in care. The restrooms have adequate toilet paper and paper towels available. The bathrooms were found to be clean. There is adequate lighting/ventilation in the bathroom area.

RM 1: ( TK-K Grade), RM 2 ( 1st-5th Grade)


All areas identified on the Facility Sketch were inspected.
RM 1: 17 children with a ratio of 2 teachers
RM 2: 25 children with a ratio of 2 teachers were inspected.

Playground equipment is in safe condition and free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The surface of the outdoor activity space is maintained in a safe condition or free of hazards. All food preparation and storage areas are clean and safe. Per Assistant Director, program provides daily snacks for children with available weekly menu. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is readily available both indoors and outdoors. The facility is equipped with a working smoke detector and carbon monoxide detector in all classrooms. LPA observed a fire extinguisher (2A 10BC) located in both classrooms serviced 12/2021. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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/WEST VALLEY ROUND MEADOW
FACILITY NUMBER: 197403242
VISIT DATE: 11/02/2022
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LPA reviewed a sample of children’s files and observed files were complete. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA reviewed a sample of staff files and observed files were complete.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited.
Licensee was provided a copy of their appeal rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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