197404234-7-21-2021-30-CC-DLOE-C55PHL-20210721112006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197404234
Report Date: 07/21/2021
Date Signed: 07/21/2021 11:20:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S		FACILITY NUMBER:	197404234
ADMINISTRATOR:	CLAUDIA CARMONA		FACILITY TYPE:	840
ADDRESS:	17160 VAN GOGH STREET		TELEPHONE:	(818) 363-6701
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	35	CENSUS: 0	DATE:	07/21/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Claudia Carmona Elias, Site Supervisor		TIME COMPLETED:	11:30 AM

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On 07/21/2021 at 8:30 a.m. Licensing Program Analysts (LPA) Deborah Lowe met with site supervisor Claudia Carmona Elias. The purpose of the visit an announce case management inspection for a capacity increase at the facility to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. No children under the license facility were present during this inspection. The program does run a day camp at this facility under the Day Camp Association. This is an application for 70 school age children, ages 4 years to 14 years old. The child care center will operate a Before and After School Age program Monday – Friday 6:30 am – 8:30 am and 1:30 pm – 6:30 pm. Full-Day available on non-school days the hours will be 6:30 a.m. – 6:30 p.m. The fire clearance was approved on 7/16/2021.

LPA Lowe toured the facility. The facility has a total of 2 classrooms on the Van Gogh Elementary School Campus. Children will have access to 4 sinks and 2 toilets within the assigned classrooms. Additional restrooms on school campus if needed.

Indoor Activity Space measurements: Under Title 22 Regulation 101538.3(c) Indoor Activity Space for School-Age Children and Health and Safety Code Section 1596.806(a)(1) a measurement of the facility is not required.

Regulation 101538.3(c) School-age childcare programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for indoor activity space:

Health and Safety Code Sections 1596.806(a)(1) : (a) A room used as a classroom by a school-age child care program shall not be required to meet the square footage or toilet requirements for child day care centers if the program is operated on (1) A functioning school site in the same facilities that have housed school children during the day, before or after school hours, or before and after school hours.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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Outdoor Play measurements: Under Title 22 Regulation 101538.2(c)(1) Outdoor Activity Space for School-Age Children and Health and Safety Code Section 1596.806(b)(1) a measurement of the outdoor activity space is not required.

Regulation 101538.2(c)(1): (c) School-age child care programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for outdoor activity space, (1) Health and Safety Code Sections 1596.806(b), (b)(1) and (d) pertain to the exemption from square-footage requirements for outdoor activity space for school-age child care programs that meet the requirements of Health and Safety Code Section 1596.806.

Health and Safety Code Section 1596.806(b)(1): (b) School grounds, other than rooms used as classrooms, used by a school-age child care program operated on a functioning school site pursuant to either paragraph (1) or (2) of subdivision (a) shall be exempt from all of the following requirements imposed by the department on child day care facilities: (1) Fencing, outdoor activity space, toilet, and isolation space requirements....
Indoor / Children’s Area:

All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard are kept free of obstruction. LPA Lowe observed the child care center to be clean, safe, sanitary and in good repair. Facility will at all times to ensure the safety and well-being of children, employees and visitors. Floors of all rooms have a surface that is safe and clean. A comfortable temperature for children shall be maintained at all times. LPA Lowe observed furniture and equipment to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs shall be provided to meet the needs of the children. All play equipment and materials used by children shall be age-appropriate. LPA Lowe observed a cubby shelf in each room for each child to have an individual permanent or portable storage space for his/her clothing, personal belongings. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. Drinking water from a Britta Water filter container is be readily available both indoors and in the outdoor activity area. Children bring their own water bottles from home. The licensee shall take measures to keep the center free of flies, other insects, and rodents. Site Supervisor stated Orkin Pest Control comes quarterly.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. One trash can near entrance door was observed without a lid. All window screens shall be in good repair and free of insects, dirt and debris. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Storage areas for poisons shall be locked. Cleaning chemicals were observed in a locked cabinet. The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children: LPA Lowe observed a current edition of a first-aid manual. Sterile first-aid dressings. Bandages or roller bandages. Adhesive tape. Scissors. Tweezers. Thermometer. Antiseptic solution.

A center shall be equipped to isolate and care for any child who becomes ill during the day. The isolation area shall be located to afford easy supervision of children by center staff. LPA Lowe observed the facility to be equipped with a mat for each ill child. The isolation area shall not be located in the kitchen area or the general-use toilet area. Facility has a two-room bungalow, Site Supervisor stated isolation is near teacher desk or outside under canopy tent.

LPA Lowe observed a carbon monoxide detector in the facility showing in good working order. Facility was also observed with two smoke detectors one in each room, Site Supervisor tested, and LPA Lowe verified good working order with hearing the testing alarm.

Facility has telephone service on the premises, LPA Lowe observed the telephone; however, line itself not in-service during summer. Site Supervisor stated service will be turned back on for the school year.

LPA Lowe observed facility’s sign-in area to have individual folders for each child for parents to sign-in. Sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the childcare center that shall, at a minimum, include the following:

The licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

Smoking is prohibited on the premises of a childcare center as specified in Health and Safety Code Section 1596.795(b).

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 3 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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A baby walker shall not be allowed on the premises of a childcare center in accordance with Health and Safety Code Sections 1596.846(b) and (c).

LPA Lowe observed a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.

Restrooms:

All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). LPA Lowe observed the hot water to be turned off.

Notwithstanding (e) and (e)(1) above, handwashing fixtures shall not be required to deliver hot water.

There shall be one toilet and one handwashing fixture, separate from and in addition to the number of toilets and handwashing fixtures required in (h) above, designated for use by children who are ill, for use by staff, and for emergency use. This toilet and handwashing fixture shall be conveniently located in relation to the isolation area. Facility was not observed with separate restroom; however, Site Supervisor stated they do have access to restrooms within the school premises.

Common towels or washcloths are prohibited.

Toilets used by school-age children shall provide individual privacy. Toilet facilities shall not be used simultaneously by children of both sexes. Two restrooms were observed one in each room as single use, one toilet and one sink in each.

Outdoor Space:

LPA Lowe observed a shaded rest area for the children under two trees located on the grass area. Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. Page 4 of 8

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 4 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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No high climbing equipment, swings, slides and other similar equipment was observed.

The playground was observed to be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

Any construction or equipment that could pose a hazard in the outdoor activity area was observed to be inaccessible to children in care by use of enclosed gate. This shall include, but not be limited to, incinerators, air- conditioning equipment, water heaters, and fuse boxes. No pools or bodies of water were observed at the facility.

Health Related Services:

Medications shall be kept in a safe place inaccessible to children. A refrigerator shall be used to store any medication that requires refrigeration. LPA Lowe observed a locked box with pad lock for storage of medications.

The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given. LPA Lowe reviewed the medication log at the facility.

Food Service:

All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. LPA Lowe observed a food cabinet and refrigerator in facility. Refrigerator was observed to be clean with appropriate temperature.

All foods or beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 5 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored. Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

LPA Lowe observed the, food-preparation and storage areas to be kept clean and free of litter and rubbish; and facility will ensure measures shall be taken to keep all such areas free of rodents and other vermin.

The food-preparation area shall not be used for: Children's play activities, unless such activities are part of a supervised food-education program. Food-prep area was observed in the classroom near the counter with sink.

Full-day programs shall offer a midmorning and a midafternoon snack. Full-day programs shall ensure that each child has a lunch. Half-day programs shall offer a midmorning or midafternoon snack.

Postings:

LPA Lowe observed required postings posted in a prominent, publicly accessible location in the center near an entrance door.

The center shall post a copy of the LIC 613A (9/96) in a prominent, publicly accessible area in the center.

The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

The licensee shall post signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5 FORM: LIC 610

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 6 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

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Each licensee shall have a disaster and mass casualty plan of action, LPA Lowe observed the facility had the disaster and mass casualty plan on site and available to view. Contingency plans for action during fires, floods and earthquakes including, but not limited to, the following: FORM: LIC 9148

The following was discussed:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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: http://www.ada.gov/childqanda.html.

Employee/Volunteer Files shall also be maintained and shall contain the following

Health Screening Report - Facility Personnel (LIC 503) and TB Clearance.
Proof of Immunizations
TB Clearance and "Good Health" statement from volunteers.
Personnel Record (LIC 501) or application/resume.
Evaluation of Director Qualifications (LIC 9096).
Evaluation of Teacher Qualifications (LIC 9095).
For each aide under age 18, verification of high school graduation or current participation in an occupational program conducted by an accredited high school or college.
Criminal Record Statement (LIC 508) for staff subject to fingerprint requirements.
Fingerprint clearances - Proof of clearance (Criminal Record, FBI and Child Abuse).
Appropriate driver's license for person(s) transporting children.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training.
Website: www.mandatedreporterca.com
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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 7 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO L.A.-NORTH VALLEY Y, VAN GOGH ELEM.S	FACILITY NUMBER: 197404234
	VISIT DATE: 07/21/2021

NARRATIVE

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Senate Bill (SB) 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

Senate Bill (SB) 277 New Immunization Requirement: Beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

The following corrections are needed before a capacity increase will be considered:

· Outlet repair needed for outlet near refrigerator – outlet is cracked.

· Ensure all trash cans have secure lids

An exit interview was conducted with the above items discussed and a copy of this report was provided to the Site Supervisor Claudia Carmona Elias and Christopher Jefferson, Vice President, YMCA Youth Development. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues. Applicant to correct items by 07/31/2020.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

Page: 8 of 8