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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198000569
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:11:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2023 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20230802154700
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: 85DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Mona Asad TIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff are operating beyond the terms and conditions of the license
Staff are allowing daycare children to be soiled while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced complaint inspection at the facility listed above. LPA met with Director Mona Asad and explained the reason for the visit. LPA observed 1 staff supervising 12 children in classroom 1, 1 staff with 13 children in classroom 2, 1 staff with 12 children in classroom 3, 2 staff with 12 children in classroom 4, 2 staff with 12 children in classroom 5, 2 staff with 13 children in classroom 6 and 2 staff with 7 children in the toddler classroom. LPA observed staff supervising children during nap time.
During the course of the investigation LPA collected pertinent information and conducted interviews. Staff interviews corroborated the allegations above. Per the Director, Staff 1 and Staff 2, children from the toddler component were taken to the two year old class in the preschool during a couple of days in the summer months. Per Staff interviewed this was done due to company ratio guidelines in which one staff member is not allowed to stay alone with children. According to the Director, per company policy, there always needs to be at least two staff members with children at all times.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 54-CC-20230802154700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/19/2023
NARRATIVE
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During the incidents, there was only one staff member available in the toddler classroom in the afternoons, therefore they combined with the Two year old class. Per Director, parents were informed that toddler children would be combined with the Two year old class but there was no written authorization. Per Director, they have since stopped combining the classrooms. Staff interviews also revealed that there was at least one incident in which a child left the facility while soiled.
Based on record review and interview, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated.

Two type B deficiencies are being cited today in accordance with California Code of Regulations Title 22:101428(b) Infant Care Personal Services and 101216.4 Preschool Program With Toddler Component

Exit interview was conducted with Director Mona Asad

The Notice of Site Visit (LIC 9213) and the Appeal Rights were given and explained to the Facility Representative. 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.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2023 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20230802154700

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: 85DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Mona Asad TIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are inappropriately changing daycare children while in care
Staff are not providing adequate supervision to daycare children
INVESTIGATION FINDINGS:
1
2
3
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5
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13
Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced complaint inspection at the facility listed above. LPA met with Director Mona Asad and explained the reason for the visit. LPA observed 1 staff supervising 12 children in classroom 1, 1 staff with 13 children in classroom 2, 1 staff with 12 children in classroom 3, 2 staff with 12 children in classroom 4, 2 staff with 12 children in classroom 5, 2 staff with 13 children in classroom 6 and 2 staff with 7 children in the toddler classroom. LPA observed staff supervising children during nap time.

During the course of the investigation LPA collected pertinent information and conducted interviews with staff and parents. Per staff interviews, children in the toddler class who wear a diaper are changed on a diaper table and if children are potty training, they are assisted in the restroom. Per parent interviews, they have not witnessed children being changed while standing if they wear a diaper. Per staff interviews children who wear diapers are changed on the diaper table and during the time toddler children were being combined with preschool children in the two year old class, they were changed before going to the two year old class.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 54-CC-20230802154700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/19/2023
NARRATIVE
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Interviews conducted revealed conflicting statements regarding if staff are not providing adequate supervision to children. Staff advised that there is a company policy in which one staff member cannot even be alone with one or two children. Per company policy, there always needs to be at least two staff members with the children. LPA reviewed facility documentation indicating that ratios are accounted for during the day to ensure proper supervision is being implemented. One parent interview revealed one incident in which according to the parent, their child suffered a minor injury but no staff observed the incident. According to the parent, they were told there was more than one staff present when the incident occurred, but they did not witness the incident. Per parent, they did recall when the incident occurred. Other parent interviews revealed they have not witnessed children not being adequately supervised.

Based on information obtained during the investigation, the allegations were determined to be unsubstantiated. Unsubstantiated – A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.



Exit interview was conducted with Director Mona Asad
The Notice of Site Visit (LIC 9213) and the Appeal Rights were given and explained to the Facility Representative. 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.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 54-CC-20230802154700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101428(b)
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101428(b)Infant Care Personal Services: The infant shall be kept clean and dry at all times. This requirement was not met as evidenced by:
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Per Director, staff was recently trained on diapering policies on 10/16/23. A staff attendace sheet for the training was provided to LPA on 10/19/23. Director will also discuss with staff ( in the toddler class and two year old class) the timeframes for checking if children need to be changed.
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Based on interview, there was at least one incident in which a child in the toddler classroom was sent home soiled. This poses a potential risk to the health and personal rights of children in care.
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 Director will provide a form verifying each staff was advised of this requirement.
POC will be submitted to LPA via email by 10/27/23.
Type B
10/27/2023
Section Cited
CCR
101216.4(1)
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101216.4(1)Preschool program with toddler component:No child in the toddler program shall be placed in the preschool program before the age of 30 months without written permission from the... authorizedrepresentative.This requirement was not met as evidenced by

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Director submitted to LPA on 10/19/23 a written statement which indicates that Director understands the toddler component and preschool component cannot be combined without written authorization.
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Based on interviews, children in the toddler porgram were placed in the two year old preschool class during a few days in the summer to meet company supervision requirements. This poses a potential risk to the safety and personal rights to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5