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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015674
Report Date: 08/24/2022
Date Signed: 08/24/2022 09:57:13 AM


Document Has Been Signed on 08/24/2022 09:57 AM - 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 LINDSTROM SITEFACILITY NUMBER:
198015674
ADMINISTRATOR:MELISSA BAEZFACILITY TYPE:
840
ADDRESS:5900 CANEHILL AVENUETELEPHONE:
(562) 916-5814
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:70CENSUS: 0DATE:
08/24/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Senior Program Director, Michele Janssen and Director, Melissa BaezTIME COMPLETED:
10:05 AM
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On August 24, 2022 at 9:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an announced inspection at the school-age program located at Esther Lindstrom Elementary and met with Senior Program Director, Michele Janssen and Director, Melissa Baez. The purpose of the inspection was to evaluate the change of classrooms at the facility. The program operates before and after school care for school age children, Monday through Friday from 2:56 pm to 6:00 pm. Early school dismissal is on Wednesday's at 1:36 pm. Per Senior Program Director, the program is not operating a morning session for this school year.

During the inspection, LPA was guided on a tour of the inside and outside of the facility by Senior Program Director and Director. This school age program utilizes the cafeteria/auditorium, Classroom 56, and Classroom 54 for child care. At the time of the inspection, no children were present.

Furniture and equipment was inspected for age appropriateness and good repair. Cafeteria tables and benches are used by children in the program. There is a stage in the cafeteria. Telephone service, heating, lighting and ventilation were evaluated. Children's belongings (i.e. backpacks and lunch bags) are hung on rolling backpack carts. Per Senior Program Director, the isolation area is located in the cafeteria. First Aid supplies were inventoried and are located inside each classroom and the cafeteria. Availability of drinking water was observed. There is water available inside each classroom and in the cafeteria. The restrooms are located on the southwest side of the school, near the cafeteria and outside lunch area. There are many restrooms with sinks and toilets on site. General sanitation was observed.

The facility was granted a fire clearance for Classrooms 56 and 54 on August 10, 2022. Fire extinguishers are fully charged and were last serviced on August 11, 2022. The facility does not have a carbon monoxide detector available. The smoke detectors were not tested during today's inspection due to the detectors being wired to the emergency pull down fire alarm.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique AyalaTELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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 LINDSTROM SITE
FACILITY NUMBER: 198015674
VISIT DATE: 08/24/2022
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The Senior Program Director will submit the following to the Department prior to use of the new classrooms:
  1. Updated Facility Sketch (LIC 999),
  2. Updated Bellflower Unified School District Application and Agreement for use of School Facilities (Classroom 56 and 54), and
  3. Photograph of a purchased carbon monoxide detector and a copy of the receipt.
Per Senior Program Director, the requested items will be submitted to LPA Ayala via e-mail by Friday, August 26th.

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 Senior Program Director, Michele Janssen. Appeal Rights were discussed, and a copy was provided to the facility representative.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique AyalaTELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
LIC809 (FAS) - (06/04)
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