304371466-2-5-2021-06-CC-KDEI-BXXUV3-20210205145429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371466
Report Date: 02/05/2021
Date Signed: 02/05/2021 02:54:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	YMCA-EASTWOOD EARLY LEARNING CENTER		FACILITY NUMBER:	304371466
ADMINISTRATOR:	EPTING, SHAUNA		FACILITY TYPE:	850
ADDRESS:	15730 PESCADOS DRIVE		TELEPHONE:	(562) 392-6488
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	36	CENSUS: 0	DATE:	02/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Ms.Epting Shauna		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Ketki Desai conducted an on-site pre-licensing announced inspection at this proposed Preschool site located on the campus of Eastwood Elementary school under La Mirada Unified School district. LPA met with Administrator Ms. Epting Shauna along with Ms. Flores Harrison (Executive Director of Youth Services and Ms. Rivers Jamilia ( Incoming Director )and toured the site. The applicant has requested to provide care and supervision for 36 Preschool age children 2-5 years of age, Monday through Friday, 6.30 am. to 6.30 PM. in the two classrooms on the school property. The two classrooms are located in Building 200, the area is at the end of the school campus with a designated area with their own restrooms and play yard in the front of the two classrooms for the proposed Preschool site. A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Entrance to the Preschool site shall be from Watkins street, backside of the school with the parking lot in front of Building 200. The building is completed fenced from all sides and has a designated fenced door for safe entrance. The two designated classrooms have their own entrance with enough light and ventilation. It has central cooling and heating system. Eastwood Elementary school has issued a permission letter to the “YMCA” program to utilize the two assigned rooms Room # 1 and 2, located in Building 200 with designated restrooms and a play yard, for outdoor activities. The restrooms are located on the same building site in front of the classrooms and the play yard. (Page -1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YMCA-EASTWOOD EARLY LEARNING CENTER	FACILITY NUMBER: 304371466
	VISIT DATE: 02/05/2021

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

Incidental Medication will be stored in the classroom in a locked cabinet and shall be administered by the teacher. Medication administration forms were reviewed. Isolation area would be behind the Director’s desk and the children shall use the designated staff restroom across the classroom.

The following were inspected in the indoor activity space:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through Brita filtered dispenser in each classroom with disposable cups
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
· Cubbies available for storage of individual child’s personal belongings
Children shall nap on Cots and Linens shall be provided by the parents and it shall be taken home on a daily basis.
Facility shall provide AM/PM snacks along with hot lunch, these shall be brought in from the other YMCA site in heated bags on a daily basis.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393) / Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies/ Plan of Corrections of Type A deficiencies
(Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YMCA-EASTWOOD EARLY LEARNING CENTER	FACILITY NUMBER: 304371466
	VISIT DATE: 02/05/2021

NARRATIVE

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The indoor activity space: There are two assigned Preschool rooms,
Room # 1: 39'08 X 23'08 = 901'97– 28'95= 873'02 (encumbered: Refrigerator and 2 cabinets) = 873'02 / 35= 24 children
Room #2: 39'08 X 23'08 = 901'97 (25 children)

Total indoor space = 1174'98 divided by 35= 50'71 ( 51 children)
Capacity requested: 36

Total sinks: 6 x 15 = 90
Total Toilets: 4 x 15= 60

LPA observed sinks and bathrooms located outside the classrooms. Toilets and sinks were observed to age appropriate in all the bathrooms observed.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers
· Outdoor activity space is supplied with age and size appropriate equipment, including outdoor activity toys
· Adequate shade is provided by shaded patio area.

Outdoor space measurements: Facility has open play yard just outside the classrooms, which has access from each of the two classrooms

Outdoor yard: 56 X 49 = 2744
Total Outdoor space: 2744 divided by 75 = 36.59 (37 children)

Based on the indoor measurements, sink and toilet availability, facility has enough space to accommodate the requested capacity for 36 children (age 2- 5 years) in the assigned two classrooms.

Fire clearance received from LA County Fire Department on 1/24/21 have approved the requested capacity of 36 preschool age children.
(Page-3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YMCA-EASTWOOD EARLY LEARNING CENTER	FACILITY NUMBER: 304371466
	VISIT DATE: 02/05/2021

NARRATIVE

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Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training along with the completion certificate for the Preventive Health training (Nutrition and Lead component)
Facility is in process of submitting the Analytical report for Water testing, which is completed annually by School District.

LPA discussed with the applicant that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant was advised the children's bedding must be stored individually and may not touch another children's bedding.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The applicant/facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YMCA-EASTWOOD EARLY LEARNING CENTER	FACILITY NUMBER: 304371466
	VISIT DATE: 02/05/2021

NARRATIVE

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AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

The facility was following Title 22 requirements at the time of the inspection.

Based on today’s measurements, and the sink and toilet availability, this center has enough activity space to support the requested capacity for 36 Preschool children. A license will be issued for the capacity requested after a final review. The applicant will be notified if any additional information is required.

Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC 809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

Exit interview was conducted and a copy of this report was provided to Ms. Epting Shauna Administrator on site.

The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

LIC809 (FAS) - (06/04)

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