197409616-6-6-2023-58-CC-DLOE-CSJVUL-20230606164455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409616
Report Date: 06/06/2023
Date Signed: 06/06/2023 04:45:04 PM

Document Has Been Signed on 06/06/2023 04:45 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/NORTH VALLEY DEARBON		FACILITY NUMBER:	197409616
ADMINISTRATOR:	HAZEL VILLARREAL		FACILITY TYPE:	840
ADDRESS:	9240 WISH AVENUE		TELEPHONE:	(310) 486-4580
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 65	TOTAL ENROLLED CHILDREN: 28	CENSUS: 25	DATE:	06/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:08 PM
MET WITH:	Hazel Villarreal		TIME COMPLETED:	04:55 PM

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On 06/06/2023 Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Annual Required Inspection and met with Director Hazel Villarreal. LPA toured the facility indoors and outdoors and a census was taken; 25 children under care and supervision of Director and 1 other staff member.

Facility is located at Dearborn Elementary School.

LPA observed YMCA has their own assigned bungalow with 2 adjoined school age classrooms. Days and hours of operation are Monday, Wednesday, Thursday, and Friday 06:30 am to 7:45 am and 2:15 pm to 6:30 pm. Tuesdays 06:30 am to 7:45 am and 1:15 pm to 6:30 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 two carbon monoxide detectors located in the classrooms. LPA was able to hear a successful test of the carbon monoxide detectors.

Outdoor area was observed to be located just outside the bungalows. Outdoor area was observed to be black top with four square court, handball courts, and kickball diamond. Outdoor area was observed to be free of any hazards.

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 were observed to be inaccessible and stored in locked classroom closet. Door of closet was observed to be labeled Chemical Storage.

All toilets and handwashing facilities are in safe and sanitary operating condition. Facility has two single use restrooms within YMCA bungalow. Floors in the facility are clean and safe.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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

FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY DEARBON	FACILITY NUMBER: 197409616
	VISIT DATE: 06/06/2023

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Facility does not have access to a kitchen. Per Director, LAUSD Dearborn Elementary School provides afternoon snacks. Facility was observed with emergency food supplies. All food is protected against contamination and any contaminated food is discarded immediately. Facility was observed with a refrigerator that was observed to be clean with thermometers, facility was observed with an up to date completed refrigerator temperature daily inspection log. Solid waste storage containers have tight-fitting covers and are in good repair.

Drinking water is available both indoors with water fountain and outdoors with use of a water container. Children have water bottles, and the facility has disposable cups available.

Facility has conducted water lead testing to comply with Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

LPA Lowe observed the following postings on the parent board located on the wall of the classroom: 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 observed on the parent board. LPA observed disaster drill log posted on the parent board showing facility is conducting disaster drills monthly.

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. LPA Lowe reviewed facility medication policy with Director, there were no medications observed at the facility during the time of this inspection. Per Director, no children are currently taking medication. LPA Lowe reviewed LIC 9040 Child Care Facility Roster.

Review of staff files show staff files to be complete with mandated reporter, immunization verification of Tdap, MMR, and flu, and health screening.

Review of facility file shows Director has CPR/First Aid that expires 09/2024 and has Preventive Health Practices with nutrition and lead components.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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 DEARBON	FACILITY NUMBER: 197409616
	VISIT DATE: 06/06/2023

NARRATIVE

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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.

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 Director Hazel Villarreal.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

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