198001217-10-28-2022-54-CC-MAYA-CKMTC4-20221028143608

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198001217
Report Date: 10/28/2022
Date Signed: 10/28/2022 02:36:18 PM

Document Has Been Signed on 10/28/2022 02:36 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 MADISON SITE		FACILITY NUMBER:	198001217
ADMINISTRATOR:	BRITNIE HARRIS		FACILITY TYPE:	840
ADDRESS:	2801 BOMBERRY		TELEPHONE:	(562) 420-6561
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	60	CENSUS: 7	DATE:	10/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Director, Starlyn Johnson		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On October 28, 2022 at 1:10 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Starlyn Johnson. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The program operates before and after school care for school age children at James Madison Elementary School, Monday through Friday from 6:30 am to 8:30 am and 1:30 pm to 6:00 pm. All areas on the facility sketch were inspected. The program provides child care in B-31 for Kindergarten to 1st grade and B-30 for 2nd grade to 8th grade. The program utilizes the gated outdoor play yard on the school campus. Upon arrival, 4 personnel and 7 children were present. LPA was informed that parents sign their children out during pick-up while staff sign the children in as soon as they arrive to the program. The following documents are posted in a prominent, publicly accessible area at the facility: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (PUB 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), Daily Activity Schedule, and Earthquake Preparedness (LIC 9148). Furniture and equipment were inspected for age appropriateness and good repair. The children have cubbies to place their belongings. Telephone service, heating, lighting and ventilation were evaluated. Sinks and toilets were inspected for availability and good repair. General sanitation was observed. Disinfectants, cleaning solutions, medication and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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 MADISON SITE	FACILITY NUMBER: 198001217
	VISIT DATE: 10/28/2022

NARRATIVE

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The facility provides the children with snacks daily. All food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. Availability of indoor and outdoor drinking water was observed (water jugs).

Carbon monoxide detector was tested and is operable. Smoke detectors were not tested during today's inspection due to smoke detectors being wired to the emergency pull down fire alarm. The fire extinguishers are fully charged and were last serviced on July 5, 2022. The facility has verification of disaster and fire drills. The last drill was conducted on October 5, 2022.

First Aid supplies were observed and kept inside each classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note. Medication is stored in a cabinet that is located in each classroom. Per Director, transportation is provided by the facility and all vehicles have the proper seat restraints for children. Per Director, the isolation area is in a designated area inside each classroom. In the designated area, a mat may be placed and the staff restroom is available for an ill child, if needed.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 conducted record reviews of 5 children’s records and 4 personnel records for completeness. Based on the record reviews, the children's records and personnel records were complete with all the required documents per licensing regulations. The names of children and staff whose records were reviewed were documented. Children's roster was reviewed and is current. There is at least one person trained in CPR and Pediatric First Aid present during this visit. All individuals present have obtained a criminal record clearance or criminal record exemption.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

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 MADISON SITE	FACILITY NUMBER: 198001217
	VISIT DATE: 10/28/2022

NARRATIVE

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Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

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/process.

No deficiencies were cited during today's inspection.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Starlyn Johnson.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

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