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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000569
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:19:23 PM


Document Has Been Signed on 06/23/2022 04:19 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:YMCA GLB MAYNE ST STATE PRESCHOOLFACILITY NUMBER:
198000569
ADMINISTRATOR:BERTINA XAVIERFACILITY TYPE:
850
ADDRESS:9630 MAYNE STREETTELEPHONE:
(562) 804-1976
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:103CENSUS: 40DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Bertina XavierTIME COMPLETED:
04:32 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year Inspection. LPA met with Director Bertina Xavier who assisted analyst with a tour of the facility. This is a Preschool Program and Toddler component. The program serves 96 preschool children ages two (2) until entry into kindergarten; and seven (7) toddlers ages 18 months to 30 months. The current hours of operation are: Monday through Friday 7:00am to 5:00pm. Both programs (indoors and outdoors) are physically separate.

Areas identified on the Facility Sketch were inspected. At approximately 1:00pm PA observed the following: Room 2 (one Teacher and five napping children), Room 3 (one teacher and 12 napping children), Room 4 (not in use during visit). Room 5 (one Teacher and 12 napping children), Room 6 (one teacher and 11 napping children), Toddler Room 7 (all toddlers gone for the day). LPA inspected classrooms, outdoor areas, furniture and equipment for good repair. LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. Napping cots are stored appropriately with bedding removed. LPA observed drinking water with drinking containers readily available in the classrooms. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. LPA issued a technical violation for hand sanitizer in classrooms. The sanitizer was semi-inaccessible (on top and in back of approximately 4ft wooden shelving). LPA informed Director to place at least 5 feet high for safety.

LPA informed Director to place hand sanitizer in a more inaccessible location at least 5 feet high. The indoor classrooms have surfaces that appear to be clean and safe. All materials and surfaces accessible to children are toxic free. Storage areas for poisons are locked in containers inaccessible to children. At this time the office is used as an isolation area to care for ill children and a cot is available for rest. Parents are also contacted immediately if children are ill. Director Xavier indicated there are no weapons at the facility and LPA did not observe any. At approximately 1:20pm LPA observed outdoor play equipment to be in good condition, free of sharp, loose or pointed parts. CONTINUED

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB MAYNE ST STATE PRESCHOOL
FACILITY NUMBER: 198000569
VISIT DATE: 06/23/2022
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Areas around and/or under climbing equipment have cushioning material to absorb a fall. All materials and surfaces accessible to children appear to be toxic free. The toddler component outdoor play area is physically separate from the preschool and the play equipment and toys are age appropriate. At 1:40pm LPA observed menus that are posted one week in advance where it is visible by the child's authorized representative. Snacks were reviewed for availability, quantity, expiration dates and appropriateness for children in care. The facility provides breakfast, lunch and a PM snack. LPA observed the food and kitchen area appearing to be in safe and sanitary condition. LPA also observed drinking water available indoors and outdoors and trash receptacles that have tight fitting covers.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements.

The facility uses electronic sign in and out (QR code) to ensure children are being properly signed in and signed out by the authorized representative. LPA conducted a Children's Records Review for completeness and to ensure children have proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights etc.on file. The facility has a 15 minute Safe Sleep Check for toddlers 18 months to under two years. The children's roster was available and current.

At approximately 2:30pm Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination, Mandated Reporter training, LPA observed at least one staff member to have current CPR (Expiration November 2022) .

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.htm

LPA observed First Aid supplies in each classroom and all medications are stored in inaccessible cabinets in the classroom and office (A Refrigerator is available if necessary). Fire extinguishers (type 2A-10BC) must be serviced at least annually (LPA observed service due date November 2022). LPA informed Director Xavier that any construction or remodeling should be reported to the Department before it occurs.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB MAYNE ST STATE PRESCHOOL
FACILITY NUMBER: 198000569
VISIT DATE: 06/23/2022
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Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Last drill was conducted in February 1, 2022. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. LPA advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. All staff are current with their Mandated Reporter Training.

LPA advised Director Xavier that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors). There were no violations of Title 22 requirements at this time.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

The Notice of Site Visit (LIC 9213 –must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00 Exit interview was conducted with Director Bertina Xavier and a copy of Appeal Rights (LIC 9058) was discussed and provided

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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