197404234-10-14-2025-58-CC-ECAO-DMFNWX-20251014105017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197404234
Report Date: 10/14/2025
Date Signed: 10/14/2025 10:50:33 AM

Document Has Been Signed on 10/14/2025 10:50 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	YMCA OF METRO LA/NORTH VALLEY VAN GOGH		FACILITY NUMBER:	197404234
ADMINISTRATOR/ DIRECTOR:	SELENA MARTINEZ		FACILITY TYPE:	840
ADDRESS:	17160 VAN GOGH STREET		TELEPHONE:	(818) 314-8894
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 70	CENSUS: 0	DATE:	10/14/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:35 AM
MET WITH:	Aneliane Mendez, Director		TIME VISIT/ INSPECTION COMPLETED:	11:05 AM

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	On 10/14/2025 at 07:35 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Annual Required Inspection. Facility is located on the Van Gogh Charter Elementary Campus at 17160 Van Gogh Street, Granada Hills, CA 91344. LPA identified self and met with Jacob Quiroz, Teacher. Shortly after, Aneliane Mendez, Director arrived at the facility. LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection. At 08:15AM, Aneliane Mendez, Director allowed entry into the facility and provided LPA a guided tour of inside and outside of the facility. There were no children present. The facility is currently licensed for a capacity of 70, per Director they currently have 32 enrolled. The facility’s hours of operation are currently Monday through Friday from 06:30 AM to 08:30 AM, Monday, Wednesday, Thursday, Friday 02:00 PM to 06:30PM and Tuesday 01:00PM to 06:30PM. Required postings were observed posted in the Adventure Classroom. The YMCA Bungalow facility is made up of 2 classrooms: Discovery Classroom Transitional Kindergarten to First Grade, 4 year olds to 6 year olds, 1 staff for 14 children and Adventure Classroom Second Grade to Fifth Grade, 7 year olds to 11 year olds, with 1 staff for 14 children. Beginning at 08:30 AM, LPA observed the following in the Discovery and Adventure Classrooms. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for each child to store their belongings. Drinking water was readily available with the use of PAGE 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY VAN GOGH	FACILITY NUMBER: 197404234
	VISIT DATE: 10/14/2025

NARRATIVE

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Brita Water Filtered water is provided. The restroom(s) were inspected for safety and sanitation. There were age-appropriate sinks and toilets located in each classroom and there was available water from the sinks, water temperature was appropriate, toilet paper was provided. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.

LPA observed a first aid kits in hanging near the door of the classrooms were inventoried for necessary supplies. LPA observed a device near a bookshelf, per Director it is a carbon monoxide detector. LPA observed smoke detector on the wall above the closet. Disaster drill log was available, and the last disaster drill was conducted on 09/29/2025. Per Director, isolation area for sick children is for the child to lay down on a mat away from other children to wait for their parent to pick them up. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in locked cabinet inside the Adventure Classroom restroom.

LPA did observe the kitchen nook / food preparation area, per Director they provide daily afternoon snacks and when the Elementary is closed the parents will provide meals. LPA reminded Director that the meals from home need to be labeled with the child’s name and stored properly.

Beginning at 09:00 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Per Director, children have access to the outdoor play area behind the YMCA Bungalow Discovery and Adventure Classrooms and the grass area located in the school playground and is shared with the Elementary School. Children do not have access to the climbing structure located in the school playground. There is adequate shade in the play yard. The children have access to filtered water from pitchers or individual water bottles or individual cups for drinking water during outdoor play. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises.

Beginning at 08:45 AM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. Criminal Record Clearances were reviewed for adults. CPR card expires on 06/2027 for Director.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

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

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY VAN GOGH	FACILITY NUMBER: 197404234
	VISIT DATE: 10/14/2025

NARRATIVE

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LPA observed that teacher-child ratios were maintained and staff names were recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed no children signed in at time of inspection.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of "medication and equipment/supplies, and reviewed children's, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY VAN GOGH	FACILITY NUMBER: 197404234
	VISIT DATE: 10/14/2025

NARRATIVE

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www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited during today’s visit.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Aneliane Mendez, Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025

LIC809 (FAS) - (06/04)

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