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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200086
Report Date: 04/12/2024
Date Signed: 04/12/2024 06:42:03 PM

Document Has Been Signed on 04/12/2024 06:42 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YMCA OF METRO LA/NORTH VALLEY CASTLEBAYFACILITY NUMBER:
191200086
ADMINISTRATOR/
DIRECTOR:		KAYLA CABRERAFACILITY TYPE:
840
ADDRESS:19010 CASTLEBAY LANETELEPHONE:
(818) 363-7414
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 27DATE:
04/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:48 PM
MET WITH:Claudia Elias, Program Director and Mayra Varona, Site CoordinatorTIME VISIT/
INSPECTION COMPLETED:
06:40 PM
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On April 12, 2024, Licensing Program Analyst (LPA) Isabel Ortega met with facility Site Coordinator, Mayra Varona to conduct an unannounced case management inspection. LPA toured two classrooms the adventure and discovery room. The purpose of this case management is to follow up on a self reported unusual incident report (UIR) submitted to the Department on April 11, 2024. The unusual incident report occurred on 4/09/2024 and incident is regarding section: 101238 Building and Grounds.

Upon arrival, there were 27 children observed in care and 5 staff proving care and supervision. Shortly after Program Director, Claudia Elias arrived at the facility.

During this inspection LPA was provided with the facility roster and other documentation related to the incident. LPA observed the classroom area where the incident occurred. In addition, LPA completed a safety inspection of the facility and interviewed staff.

According to interviews conducted with staff the food/utensil cabinet was not properly closed therefore, child #1 was able to assess the utensil container which contained an orange knife. According to facility, the next day school campus law enforcement arrived at the facility and interviewed staff. Facility has replaced the cabinet lock, LPA observed a pad lock on the food/utensil cabinet and the knife has been removed. According to facility the orange knife was utilized for snack/fruit cutting by staff. Facility also stated only plastic knives will be allowed.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY CASTLEBAY
FACILITY NUMBER: 191200086
VISIT DATE: 04/12/2024
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Facility is cited Type A deficiency according to the California Code Title 22 Regulations.
Upon receipt of a Type A deficiency facility shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

A notice of site visit was provided and requested to be posted for 30 days.

An exit interview was conducted, a copy of this report, notice of site visit and appeal rights were provided to facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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Document Has Been Signed on 04/12/2024 06:42 PM - It Cannot Be Edited


Created By: Isabel Ortega On 04/12/2024 at 06:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY CASTLEBAY
FACILITY NUMBER: 191200086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2024
Section Cited
CCR
101238

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Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met by...

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Facility will maintain supervision at all times and ensure the cabinets with locks remain locked during hours of operation.
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LPA's observation and interviews disclosed the utensil cabinet was not properly locked and or broken. Therefore, the knife was accessible to child #1. This posed an immediate danger to the health and safety of children in care and staff.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


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