198001217-3-30-2023-54-CC-MAYA-CQEVHL-20230330162718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198001217
Report Date: 03/30/2023
Date Signed: 03/30/2023 04:27:34 PM

Document Has Been Signed on 03/30/2023 04:27 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	YMCA GLB MADISON SITE		FACILITY NUMBER:	198001217
ADMINISTRATOR:	STARLYN JOHNSON		FACILITY TYPE:	840
ADDRESS:	2801 BOMBERRY		TELEPHONE:	(562) 756-6808
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 62	CENSUS: 48	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Director, Starlyn Johnson		TIME COMPLETED:	04:35 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 March 30, 2023 at 2:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Starlyn Johnson. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The program operates before and after school care for school age children at James Madison Elementary School, Monday through Friday from 6:30 am to 8:30 am and 1:30 pm to 6:00 pm. All areas on the facility sketch were inspected. The program provides child care in B-31 for Kindergarten to 1st grade and B-30 for 2nd grade to 8th grade. The program utilizes the gated outdoor play yard on the school campus for outdoor activity. Upon arrival, Director and Staff (S1) were inside B-31 with 22 children present, and S2, S3, S4, and 26 children were outside in the outdoor play yard. LPA was informed that parents sign their children out during pick-up while staff sign the children in as soon as they arrive to the program. The following documents are posted in a prominent, publicly accessible area at the facility: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (PUB 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), Daily Activity Schedule, and Earthquake Preparedness (LIC 9148). Furniture and equipment were inspected for age appropriateness and good repair. LPA did not observe storage space available for children to place their belongings. Telephone service, heating, lighting and ventilation were evaluated. Sinks and toilets were inspected for availability and good repair. General sanitation was observed. Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB MADISON SITE	FACILITY NUMBER: 198001217
	VISIT DATE: 03/30/2023

NARRATIVE

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The facility provides the children with snacks daily. All food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. Availability of indoor and outdoor drinking water was observed (water jugs, disposable cups, and outdoor drinking fountains).

Carbon monoxide detector was tested and is operable. Smoke detectors were not tested during today's inspection due to smoke detectors being wired to the emergency pull down fire alarm. The fire extinguishers are fully charged and were last serviced on July 5, 2022. The facility has verification of disaster and fire drills. The last drill was conducted on March 9, 2023.

First Aid supplies were observed and kept inside each classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note. Medication is stored in a cabinet that is located in each classroom. Per Director, transportation is provided by the facility and all vehicles have the proper seat restraints for children. Per Director, the isolation area is in a designated area inside each classroom. In the designated area, a mat may be placed and the staff restroom is available for an ill child, if needed.

This facility provides Incidental Medical Services – IMS. Per Director, no children enrolled required medication at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: http://www.ada.gov/childqanda.htm.

LPA conducted record reviews of 5 children’s records and 5 personnel records for completeness. Based on the records review, the children's records were complete with all the required documents per licensing regulations while Staff (S1) was missing the Mandated Reporter training for Child Care Providers (AB 1207). The names of children and staff whose records were reviewed were documented. Children's roster was reviewed and is current. There is at least one person trained in CPR and Pediatric First Aid present during this visit. All individuals present have obtained a criminal record clearance or criminal record exemption.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB MADISON SITE	FACILITY NUMBER: 198001217
	VISIT DATE: 03/30/2023

NARRATIVE

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Director 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 advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

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.

Deficiencies were cited during today's inspection (refer to deficiency page).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with Director, Starlyn Johnson.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/30/2023 04:27 PM - It Cannot Be Edited

Created By: Monique Ayala On 03/30/2023 at 04:04 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB MADISON SITE	FACILITY NUMBER: 198001217
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 4 personnel records (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	S1 will complete the required Mandated Reporter training for Child Care Providers (AB 1207), and the licensee will submit proof of completion to LPA via email by April 28th.

Type B

Section Cited

CCR

101238.4(a)

(a) The licensee shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as both classrooms did not have storage space available for the children's belongings which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	The facility will have individual permanent or portable storage space made available for children to store their personal belongings, and will submit proof of completion (photographs) to LPA via email by April 28th.

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:

Ana Chico

LICENSING EVALUATOR NAME:

Monique Ayala

LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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