198019459-10-12-2021-30-CC-SPOL-C7QTAR-20211012143358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019459
Report Date: 10/12/2021
Date Signed: 10/12/2021 02:34:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	BURBANK COMMUNITY YMCA		FACILITY NUMBER:	198019459
ADMINISTRATOR:	ANGELA BUCK		FACILITY TYPE:	830
ADDRESS:	332 SAN JOSE AVE		TELEPHONE:	(818) 562-5461
CITY:	BURBANK	STATE: CA	ZIP CODE:	91502
CAPACITY:	24	CENSUS: 7	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Rita Greenspan and Angela Buck		TIME COMPLETED:	02:57 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced Required 1 Year Inspection was conducted on this day by Licensing Program Analyst (LPA) Shandra Powell in accordance with Community Care Licensing (CCL) Title 22 Division 12 Chapter 1, governing Infant Child Care Centers. Facility is currently licensed for a capacity of 24. LPA met with Administrator Angela Buck and Director Rita Greenspan. The program currently operates Monday thru Friday from 7:00am to 6:00pm. LPA was taken on a guided tour of the facility of both indoors and outdoors The facility is operating out of Class Room #2 for all Infants enrolled at this time. Class Room #1 had no children in attendance during inspection. During the site inspection, there is a total census of 7 infants present and a total census of two teachers present. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for infants’ belongings and napping equipment/cribs was inspected and meet all regulatory requirements. Availability of drinking water was reviewed. The children have their own sippy-cups with their names written on them. Sinks were inspected for availability, good repair, safety and sanitation. Changing table has raised sides at least three inches high and is within an arm’s reach of a hand washing sink that delivers hot running water for staff hand washing. Toys observed to be clean. A first aid kit is kept in the classroom. Carbon monoxide detectors and smoke detectors are present in the facility and in operable condition. Fire extinguisher serviced in August 2021 as noted on the service tag. Storage cabinet in changing room was locked and hazardous items including poisonous cleaning compounds were stored inaccessible to children. Facility and parents provide bedding materials which are laundered at the facility and homes. Storage for children's belongings was reviewed. Food preparation areas were toured for safety, cleanliness and proper equipment. Bottles, dishes, and containers were labeled with infants’ names; dates were visible on all children's bottles and other refrigerated items.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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

FACILITY NAME: BURBANK COMMUNITY YMCA	FACILITY NUMBER: 198019459
	VISIT DATE: 10/12/2021

NARRATIVE

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Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade and fencing were inspected. LPA advised that the Infants need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. Infants use their own sippy-cups with their name written on the cups when outdoors. Play area was inspected for hazards and inaccessibility to bodies of water. No hazards or bodies of water observed.

Teacher-infant ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of infants are met and appropriate. Infant Needs and Assessments are done Bi-monthly . Sign-in and out sheets and procedures were reviewed. Personal Rights of infants were observed by LPA. Staff and Infant Records were reviewed for completeness. Inspection of required forms made.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. Staff #1 has Adult & Pediatric First Aid/CPR/AED card provided by the American Red Cross completed on 06/17/2021 and is valid for two years. Staff #1 had no proof of immunization's during inspection. Staff #1 will provide proof by Friday Oct 15, 2021.

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

The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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

FACILITY NAME: BURBANK COMMUNITY YMCA	FACILITY NUMBER: 198019459
	VISIT DATE: 10/12/2021

NARRATIVE

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The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. Safe Sleep - Frequently Asked Questions, Infant Sleeping Log (sample), LIC 9227 was discussed, and a Drill Log.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

Director advised that indoor and outdoor supervision required at all times.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Exit interview, copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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