197494851-7-5-2023-58-CC-LSTN-CTFTT2-20230705150002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494851
Report Date: 07/05/2023
Date Signed: 07/05/2023 03:00:11 PM

Document Has Been Signed on 07/05/2023 03:00 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:	BURBANK YMCA CHILDRENS CENTER PRESCHOOL		FACILITY NUMBER:	197494851
ADMINISTRATOR:	ANGELA BUCK		FACILITY TYPE:	850
ADDRESS:	3401 SCOTT RD		TELEPHONE:	(818) 729-1650
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY: 146	TOTAL ENROLLED CHILDREN: 146	CENSUS:	DATE:	07/05/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:32 AM
MET WITH:	Dierik Gonzalez, Director		TIME COMPLETED:	03:15 PM

NARRATIVE

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Licensing Program Analysts (LPA) Laticia Thompson conducted an unannounced case management inspection on 07/05/2023 due to an incident that was reported to the department. LPA met with Dierik Gonzalez, Director, who guided LPA on a tour of the facility. The facility is located on a Burbank Unified School District Site. There were 25 children with 6 staff present upon arrival.

LPA conducted interviews and obtained documentation.

The incident that occurred on 04/25/2023, the incident was reported to the Department on 04/26/2023, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence

Information reported to the Department indicated that Child#1 accessed a bag that contained a prescription bottle.

Based upon information received from the interviews conducted and documentation obtained it was determined Child #1 and Child#2 was not supervised when Child#1 managed to gain access to a prescription bottle. An interview conducted with Parent#1 revealed that Parent #1 observed Child#1 accessing a Portos bag hanging from the fence of the playground. Parent#1 observed C#1 pull out a prescription bottle from the bag. When Parent#1 observed Child#1 handling the medicine container Parent#1 immediately removed the container from Child#1 and turned the item over to Staff#2.

An interview with the Staff#1 revealed that the prescription bottle belonged to a staff member of the Burbank Unified School District (BUSD). Staff#1 stated an Interval Investigation was conducted. . --Page1 of 2

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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: BURBANK YMCA CHILDRENS CENTER PRESCHOOL	FACILITY NUMBER: 197494851
	VISIT DATE: 07/05/2023

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The investigation has been complete with BUSD regarding the employee. The substance came back as a non-elicit dietary supplement. The BUSD has removed the employee from the school site were the YMCA facility is located.

Based on interview with Staff#2, was supervising 8 children on the day of the incident. Staff#2 assistant left for the day at 5:15 since the facility was within ratio. Staff#2 stated they was preoccupied changing a diaper and logging out Child#2, when Child#1 gained access to a prescription bottle. Staff#2 was informed of the incident by Parent#1. This incident possess a potential health and safety risk to children in care.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22, Division 12 Chapter 1 Article 6 101229(a)(1)

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Dierik Gonzalez, Director, including, but not limited to Provider Rights, Appeal Procedures

--Page 2 of 2

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/05/2023 03:00 PM - It Cannot Be Edited

Created By: Laticia S Thompson On 07/05/2023 at 02:10 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: BURBANK YMCA CHILDRENS CENTER PRESCHOOL	FACILITY NUMBER: 197494851
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/05/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision as necessary to meet the children's needs...Supervision shall include visual observation. This requirment was not met as evidenced by	1 2 3 4 5 6 7	The director developed a daily checklist to ensure the safety of children within the classrooms, outdor, patio and bike path classroom. The checklist must be completed by staff twice day. A copy
	8 9 10 11 12 13 14	Based on S#2 did not provide visual observation when C#1 accessed a prescription bottle located on gate within the facility. This poses a potential health and safety, and personal rights risk to children in care.	8 9 10 11 12 13 14	was provided to LPA and will be placed in facility file located at the Regional Office. Staff will call for assistance when needed for addtional supervision.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Rita Ramos

LICENSING EVALUATOR NAME:

Laticia S Thompson

LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC809 (FAS) - (06/04)

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