197408524-2-7-2023-58-CC-DLOE-CNU3YW-20230207174038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408524
Report Date: 02/07/2023
Date Signed: 02/07/2023 05:40:51 PM

Document Has Been Signed on 02/07/2023 05:40 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	YMCA OF METRO LA/WEST VALLEY POMELO		FACILITY NUMBER:	197408524
ADMINISTRATOR:	MAITE FIERRO		FACILITY TYPE:	840
ADDRESS:	7633 MARCH AVENUE		TELEPHONE:	(818) 426-7151
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 39	CENSUS: 32	DATE:	02/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Breanna MacDowall, Assistant Director		TIME COMPLETED:	05:45 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

On 02/07/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Annual Required Inspection at facility located at 7633 March Ave, West Hills, CA 91304 and met with Assistant Director, Breanna MacDowall. LPA toured the facility indoors and outdoors and a census was taken; 32 children under care and supervision of 3 staff members.

Facility is located at Pomelo Elementary School.

LPA observed 2 school age classrooms, Room 29 and Room 30 are used by YMCA. Days and hours of operation are Monday, Wednesday, Thursday, and Friday 2:35 pm to 6:00 pm. Tuesdays 1:35 pm to 6:00 pm.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Tables and chairs meet the needs of the children in care. LPA Lowe observed a carbon monoxide detector in each classroom, LPA was able to hear a successful test of each carbon monoxide detector.

Per Assistant Director Outdoor Playground is located between the grass area and the blacktop basketball courts. Climbing structure was observed; however, per Assistant Director the climbing structures is off-limits for YMCA children. No sandboxes were observed in the outdoor playground. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards.

Medications are made inaccessible and stored in a locked cabinet. Facility has one child who has prescribed medication. LPA reviewed medical authorization. LPA Lowe observed 1 Epi Pen not in the original container and without the prescription label. LPA advised per CC Regulation 101226(e)(1)(B) Health-Related Services (e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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/WEST VALLEY POMELO	FACILITY NUMBER: 197408524
	VISIT DATE: 02/07/2023

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
26
27
28
29
30
31
32

Facility is located on a Los Angeles Unified School District campus, pest control is provided by LAUSD. LPA observed the facility to be free of flies, insects and rodents. No poisons were observed in today’s inspection.

Disinfectants, cleaning solutions and other hazardous items are made inaccessible and stored in locked classroom cabinet. Cabinets were made inaccessible by use of pad locks.

All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

Facility does not have access to a kitchen. Facility provides afternoon snacks. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair.

Drinking water is available both indoors and outdoors with use of gallon size water bottles from the store and the water faucet located in room 30. LPA Lowe observed a blue Igloo water cooler in the classroom and was taken outdoors when the children were outdoors. Children have water bottles and the facility has disposable cups available.

All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 14 children in care.

LPA Lowe observed the following postings on the parent boards in rooms 29 and 30: Facility License, LIC 613A (9/96), the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems, and a contingency plan for action during fires, floods and earthquakes. Menu was also posted on the parent board in room 29 and 30.

LPA reviewed a sample of children’s files and observed files to be complete. YMCA uses an electronic document system. A printed copy of all electronic files was available for view.

YMCA keeps staff files at a centralized location, due to the time of day and traffic, LPA was not able to view staff files during this visit. YMCA shall email LPA Lowe the requested staff files on 02/08/2023 for LPA to review. Review of facility file shows Director has CPR/First Aid completed on 01/09/2022 and has Preventive Health Practices with nutrition and lead components.

The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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/WEST VALLEY POMELO	FACILITY NUMBER: 197408524
	VISIT DATE: 02/07/2023

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
26
27
28
29
30
31
32

absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA observed sign out sheets with a section for parent/ guardian to sign out using a full legal signature.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA and facility representative discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

At 5:00 pm Director Maite Fierro arrived at facility.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and appeal rights and this report was reviewed with facility representative Maite Fierro and Breanna MacDowall.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 02/07/2023 05:40 PM - It Cannot Be Edited

Created By: Deborah Lowe On 02/07/2023 at 05:14 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YMCA OF METRO LA/WEST VALLEY POMELO	FACILITY NUMBER: 197408524
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

CCR

101226(e)(1)(B)

Health-Related Services

(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in Epi Pen was observed in a zip lock bag in a locked cabinet without an original unaltered label. No prescription label was on the epi pen which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/10/2023
	Plan of Correction
1 2 3 4	Per Director they will contact the parent and request the original box with prescription label, Director will email LPA Lowe with a picture of the box and label received on or before end of business on 02/10/2023. Director will submit a declaration of understanding of Regulation 101226(e)(1)(B) on or before end of business on 02/10/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Lisa Rios

LICENSING EVALUATOR NAME:

Deborah Lowe

LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4