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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017013
Report Date: 03/13/2023
Date Signed: 03/13/2023 12:26:33 PM

Document Has Been Signed on 03/13/2023 12:26 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
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: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 0DATE:
03/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director Michelle JensenTIME COMPLETED:
12:36 PM
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Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted an unannounced annual required inspection at the above facility. LPAs met with Director Michelle Janssen, who guided analysts on a tour of the facility. Per Director, operation days/hours are Monday thru Friday with a morning and afternoon schedule. Children come to the facility from 6:30 AM- 9:00 AM before school and after school children come in from 1:30 PM- 6:00 PM.
The facility has three classrooms (Fellowship room, computer lab, gym room) where care is provided. LPAs observed no children at the time of inspection. The following was observed during the tour of the facility:

LPAs toured three classrooms. All classrooms were observed to be clean and in good repair. The floors were clean and lighting was in operable condition. There were age appropriate toys and equipment. Per Director, children use the drinking fountain/ water dispenser located in the hallway. Each child brings their own drinking water which is labeled with their names. LPA observed cubbies/storage area for children to store their personal belongings. Smoke detector and carbon monoxide detector were observed to be in operable condition. LPA observed Fire extinguisher indicated fully charged last serviced on 3/3/23. First Aid kit was observed and inventoried. Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. Disinfectants and cleaning solutions were observed to be inaccessible to children in care. Per Director, there are no poisons stored at the facility. Children do not sleep as this is after school program. Per Director, the isolation area is located in the hallway between the Directors office and the reception desk. Per Director, no children require medication. LPA observed a locked empty medicine cabinet in the Directors office inaccessible to children in care.

LPAs toured the outdoor play area. Outdoor area was observed to have age-appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPAs observed required cushioning under climbing structure to absorb a fall.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB LOS CERRITOS
FACILITY NUMBER: 198017013
VISIT DATE: 03/13/2023
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Required shade was observed in the outdoor area. Per Director, water is provided in water jugs when children are using the outdoor area. LPAs also observed a water fountain in the outdoor area that is accessible for children. Per Director children bring their own water bottles from home and use the water dispenser in the hallway if needed. Cups are also provided to children if needed. LPA observed no bodies of water on the premises.

LPA observed the kitchen area, food preparation area, and food storage area to be clean and free of litter, rubbish, rodents, and/or any other vermin. Per Director, food is provided by the school district daily. LPA observed refrigerator to be clean and in operable condition. LPA observed items in the refrigerator not to be expired. LPA observed a current Children's roster.

LPA observed required posted documentation which included, Facility License, LIC610- Emergency Disaster Plan, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights and Lunch/Snack Menus. All documents were observed in a prominent, publicly accessible area of the facility.

LPA observed Sign in/out sheets, LIC 9148 Earthquake Preparedness, Daily Activity Schedule, and Verification of Disaster and Fire Drills (last conducted in 2/7/23). LPA observed three out of 50 children not to be signed out. Director was advised that children should be signed in and out daily.

Children’s records were reviewed for LIC 613A- Personal Rights, Admission Agreement, Immunization Records, LIC 700- Identification and Emergency Information, LIC 701- Physician’s Report, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights. All records were observed to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, staff qualifications, LIC 508-Criminal Record Statement, LIC 503- Health Screening Report, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. S5 did not have the mandated reporter training certificate at the time of inspection. Director was advised that mandated reporter training should be taken every two years.

Poisoning Facts Flyer (PUB 515) – All licensees (Child Care Centers) must provide the following flyer to parents and families upon enrolling or re-enrolling any child. PIN 21-21-CCP: Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB LOS CERRITOS
FACILITY NUMBER: 198017013
VISIT DATE: 03/13/2023
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6. PIN 22-06-CCP: Lead Testing in Child Care Center – Frequently Asked Questions
7. Lead Testing in Child Care Centers Frequently Asked Questions (regarding your questions, please refer to Q23, Q24, Q29, Q34, and PIN 21-21-CCP). Please visit the Lead Toxicity Prevention and Water Testing Information website for additional information and resources regarding lead testing in licensed childcare centers by visiting the following weblink: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.
For any additional questions, please email: CCCWaterTesting@dss.ca.gov.
Lead Testing was conducted on 12/29/22 for water sources used for drinking and meal prepping. Lead testing report shows no lead exceedance. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. 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. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

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.

Based on the LPA’s observation and record review no deficiencies will be cited today 3/13/23.


A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview was conducted and report was reviewed with the Director. Appeal rights were discussed and provided to Director.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
LIC809 (FAS) - (06/04)
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