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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418587
Report Date: 08/19/2019
Date Signed: 08/19/2019 01:48:48 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.-PORTER RANCH COMMUNITY CENTERFACILITY NUMBER:
197418587
ADMINISTRATOR:POWELL, AMANDAFACILITY TYPE:
840
ADDRESS:12450 MASON AVENUETELEPHONE:
(818) 368-3231
CITY:PORTER RANCHSTATE: CAZIP CODE:
91326
CAPACITY:120CENSUS: 0DATE:
08/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Chris JeffersonTIME COMPLETED:
02:02 PM
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Licensing Program Analysts (LPA's) Lawson and Maddox conducted an unannounced Case Management Inspection. LPAs met with Associate Executive Director, Chris Jefferson, who facilitated the tour of the School Age Program. Facility had previously been on inactive status and plans to resume operation on 08/20/2019. Center operates out of Bungalows 31, 32, 33 (previously numbered 34, 35, 36) and Library. Hours of operation are Monday - Friday from 6:30 AM - 8:00 AM and 2:19 PM - 6:30PM. On Tuesday the afternoon hours are from 1:19 PM - 6:30 PM.

Furniture and equipment were inspected for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies and coat hooks for children's belongings. LPAs observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water dispensers and disposable cups. There is a fire extinguisher, smoke detector and a carbon monoxide detector on the premises. There is a First Aid Kit.

LPAs inspected and observed two clean bathrooms one for girls (5 toilets and 2 sinks) and boys (2 toilet, 2 urinal and 2 sinks). Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and hand dryers readily available.

Facility is in accordance with Title 22 Regulations and is ready to become active.

An exit interview was conducted with Chris Jefferson. Consultation provided. A copy of this report was read and provided.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee LawsonTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019
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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