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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000062
Report Date: 10/18/2022
Date Signed: 10/18/2022 03:17:12 PM

Document Has Been Signed on 10/18/2022 03:17 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA GLB WEINGART-LAKEWOOD YMCA SITEFACILITY NUMBER:
198000062
ADMINISTRATOR:CHANELLE COLLOFACILITY TYPE:
840
ADDRESS:5835 E. CARSON ST.TELEPHONE:
(562) 425-7431
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Program Manager, Jessica QuinteroTIME COMPLETED:
03:30 PM
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On October 18, 2022 at 2:55 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Program Manager, Jessica Quintero. The purpose of the inspection was to conduct the Required 1 Year inspection however, Program Manager stated that the program is currently not operating and requested to be placed on inactive status. At the time of the inspection, no children were present. LPA obtained a copy of the Request for Inactive Child Care License Status (LIC 9211).

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Facility Representative, Jessica Quintero.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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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