198010530-5-3-2023-58-CC-DLOE-CRH3QA-20230503182650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010530
Report Date: 05/03/2023
Date Signed: 05/03/2023 06:26:58 PM

Document Has Been Signed on 05/03/2023 06:26 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BURBANK COMMUNITY YMCA SCHOOL AGED CHILD CARE		FACILITY NUMBER:	198010530
ADMINISTRATOR:	BUCK, ANGELA		FACILITY TYPE:	840
ADDRESS:	332 E. SAN JOSE AVENUE		TELEPHONE:	(818) 562-5461
CITY:	BURBANK	STATE: CA	ZIP CODE:	91502
CAPACITY:	90	CENSUS: 44	DATE:	05/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rita Greenspan		TIME COMPLETED:	06:20 PM

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On 05/03/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Annual Required Inspection and met with Director Rita Greenspan. LPA toured the facility indoors and outdoors and a census was taken; 44 children under care and supervision of 7 staff members.

School Age classrooms were observed to be on the 2^nd floor in rooms 201, 202, and 203.

LPA Lowe reviewed and verified staff background check associations with the Director, LPA found S4 was observed without an active background clearance. LPA advised per CC 101170(e)(1) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. Facility will receive a type A citation for this violation with a civil penalty of $500. Director corrected during visit by sending S4 home. Director provided S4 with a live scan document for background clearance.

At 3:55 pm a teacher’s aide S1 was left without a qualified teacher with 11 school age children to supervise children during a Drum Roll enrichment activity located in the main YMCA building next door until 4:45 pm. LPA Lowe advised per CC 101516.5(b)(1) Teacher-Child Ratio (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. Facility will receive a type A citation for this violation.

Furniture and equipment were observed to be in good condition, free of sharp, loose or pointed parts. Tables and chairs meet the needs of the children in care. LPA Lowe observed a carbon monoxide detector located in each classroom. LPA was able to hear a successful test of the carbon monoxide detectors.

Outdoor area was observed to be clean with equipment in good condition.

Facility has a monthly pest control service. LPA observed the facility to be free of flies, insects and rodents. No poisons were observed in today’s inspection.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK COMMUNITY YMCA SCHOOL AGED CHILD CARE	FACILITY NUMBER: 198010530
	VISIT DATE: 05/03/2023

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Disinfectants, cleaning solutions and other hazardous items were observed to be inaccessible and stored in locked classroom cabinet. Cabinets were made inaccessible by use of child safety latches.

All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

Facility kitchen was observed to be clean, food stored in containers, with enough food for the quantity needed. Facility provides all meals. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair.

Drinking water is available both indoors and outdoors with use of a water fountains.

Facility has conducted water lead testing to comply with Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

LPA Lowe observed the following postings on the parent board located in the lobby and in classrooms: Facility License, LIC 613A (9/96), the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems, and a contingency plan for action during fires, floods and earthquakes. Menu was observed on the parent board. LPA observed disaster drill log showing facility is conducting disaster drills monthly.

LPA reviewed a sample of children’s files and observed files to be complete. LPA Lowe reviewed facility medication policy with Director, LPA observed medication stored in a locked box located in the office with medication in the original container with the prescription label attached. LPA reviewed medication authorization forms to be in compliance.

Review of staff files show staff files to be complete with mandated reporter, immunization verification of Tdap, MMR, and flu, and health screening. Review of staff files show 2 staff with a current pediatric CPR/First Aid. Director file was reviewed with Preventive Health Practices.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA observed sign out sheets with a section for parent/ guardian to sign out using a full legal signature. page 2 of 3

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK COMMUNITY YMCA SCHOOL AGED CHILD CARE	FACILITY NUMBER: 198010530
	VISIT DATE: 05/03/2023

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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.

Facility representative 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 and facility representative discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

LPA Deborah Lowe informed facility representative Rita Greenspan that this report dated 05/03/2023 document(s) two Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the facility representative to provide a copy of this licensing report dated 05/03/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and appeal rights and this report was reviewed with Director Rita Greenspan.

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SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 05/03/2023 06:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: BURBANK COMMUNITY YMCA SCHOOL AGED CHILD CARE	FACILITY NUMBER: 198010530
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)(1)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Staff S4 did not have an active background clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2023
	Plan of Correction
1 2 3 4	Director sent staff S4 home, Director provided staff with a live scan form to obain background clearance. Director provided LPA Lowe with a declaration with a plan to change the current hiring process to ensure background clearances are completed before staff are present in facility.

Type A

Section Cited

CCR

101516.5(b)(1)

Teacher-Child Ratio

(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance. (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview with Director and staff S1, and record review of employee file, the licensee did not comply with the section cited above in staff S1 a teacher aide was left alone with 11 school age chidlren for 50 minutes which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2023
	Plan of Correction
1 2 3 4	LPA verified qualified teacher was placed in room with teacher aide at the end of the enrichment class. Director provided a declaration with a plan for all staff to understand staffing qualifications and ratios to be maintained to ensure an aide is not left alone with chidlren. Director will meet with staff and send meeting agenda with staff signatures by end of business on or before 05/05/2023.

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

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