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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017013
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:09:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
11/08/2023 and conducted by Evaluator Katrina Chicote
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20231108095609
FACILITY NAME:YMCA GLB LOS CERRITOSFACILITY NUMBER:
198017013
ADMINISTRATOR:MICHELE JANSSENFACILITY TYPE:
840
ADDRESS:15530 WOODRUFF AVENUETELEPHONE:
(562) 925-1292
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:80CENSUS: 15DATE:
11/13/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle Janssen, Facility Representative (FR)TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Conduct Inimical
INVESTIGATION FINDINGS:
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On 11/13/2023 at 2:00 PM Licensing Program Analyst (LPA) Katrina Chicote and Licensing Program Manager (LPM) Denise Gibbs conducted an Unannounced Complaint Inspection for the purpose of initiating the 10-day and delivering findings for the above allegation. Licensing Staff announced purpose of visit and met with Michelle Janssen, Facility Representative. Census was taken. LPA observed 15 school age children with four staff upon arrival to facility.

On or about 09/04/2022, Staff One (S1) was arrested. After speaking with FRs, it's been determined that S1 was not present at this location and health and safety of children were not compromised. Per documents obtained, the alleged victim was an adult and the incident occurred was away from the facility. The above allegation is substantiated, however FR states that S1 was never at this location. Per S2, S1 worked as Transporation Coordinator and would conduct pick ups and drop offs at two YMCA locations (Gompers #19160884 and Madison #198001217). S2 states that he would fill in at times when needed but was never alone with the children. S2 states they were notified of S1's felony conviction and upon notification was immediately removed with their last day being on 10/25/2023.
Report Continues - Page 1 of 2
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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 2
Control Number 54-CC-20231108095609
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB LOS CERRITOS
FACILITY NUMBER: 198017013
VISIT DATE: 11/13/2023
NARRATIVE
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The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited in regards to this allegation.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Michelle Janssen, Facility Representative.


Report Ends - Page 2 of 2
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2