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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019117
Report Date: 04/07/2022
Date Signed: 04/07/2022 09:34:49 AM


Document Has Been Signed on 04/07/2022 09:34 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:YMCA OF GREATER WHITTIERFACILITY NUMBER:
198019117
ADMINISTRATOR:SUSETTE SEPULVEDAFACILITY TYPE:
850
ADDRESS:12510 HADLEY ST.TELEPHONE:
(562) 392-6119
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:42CENSUS: 17DATE:
04/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Teachers, Hanna Esquivel & Reanna SotoTIME COMPLETED:
09:45 AM
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At approximately 9:00 AM, Licensing Program Analysts (LPA's) Bardo Baluyot and Carolyn Tuba conducted an unannounced follow up inspection to amend a report issued by LPA Baluyot on 3/25/22. A COVID-19 risk assessment was conducted upon entering the facility. LPA's met with Teachers, Hanna Esquivel and Reanna Soto who guided the LPA on a tour of the facility. LPA's observed eight (8) children in Room #1 and nine (9) children upon arrival. Required Teacher-child ratio was observed. Director, Brittany Wallace arrived a short time later.


The Notice of Site Visit (LIC 9213) – was provided and must remain posted for 30 days.

Exit interview was conducted with Director, Brittany Wallace. Appeal rights were explained and provided.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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