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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408524
Report Date: 05/13/2026
Date Signed: 05/13/2026 03:59:56 PM

Document Has Been Signed on 05/13/2026 03:59 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 POMELOFACILITY NUMBER:
197408524
ADMINISTRATOR/
DIRECTOR:		MARILYN RODRIGUEZFACILITY TYPE:
840
ADDRESS:7633 MARCH AVENUETELEPHONE:
(818) 426-7151
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY: 80TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
05/13/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Marilyn RodriguezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Tatiana Bickham conducted an unannounced 3 Year Required Inspection at facility located at the above facility on 05/13/2026 at 2:25 PM. LPA met with Director, Marilyn Rodgriguez. LPA toured the facility indoors and outdoors and a census was taken; 17 children under care and supervision of 2 staff members.

Teacher/child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license.

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-Friday 7:00 am- 8:15 am, 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 observed a carbon monoxide detector, LPA was able to hear a successful test of the carbon monoxide detector.

Per Director Outdoor Playground is located between the grass area and the blacktop basketball courts. 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.

Per Director, the facility does not administer prescription medication.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Tatiana Bickham
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2026
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/WEST VALLEY POMELO
FACILITY NUMBER: 197408524
VISIT DATE: 05/13/2026
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

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 cabinets. 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 indoor classroom with use of water faucet located in room 30. LPA observed the facility tested their water for lead in December 2022. The facility has one faucet that has a high lead exceedance, LPA observed the faucet to have signage and is wrapped making the faucet inaccessible to children in care. LPA reminded the Director the water must be tested for lead once every 5 years.

All children are under supervision, including visual supervision, of a teacher at all times.

LPA 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.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Tatiana Bickham
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
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/WEST VALLEY POMELO
FACILITY NUMBER: 197408524
VISIT DATE: 05/13/2026
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A sample of children’s records were reviewed for Admission Agreement, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights,LIC 613-Personal Rights, LIC 702-Health History, and LIC 701 Physician Report.

Staff records were reviewed for Education, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, LIC503- Health Screening, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

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.

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.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview conducted and report was reviewed with Director, Marilyn Rodriguez. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

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

Page 3.

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Tatiana Bickham
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC809 (FAS) - (06/04)
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