198015310-11-4-2022-54-CC-MAYA-CKUUE3-20221104153027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015310
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:30:39 PM

Document Has Been Signed on 11/04/2022 03:30 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 STEPHEN FOSTER STATE SA SITE		FACILITY NUMBER:	198015310
ADMINISTRATOR:	VIRIDIANA MUNOZ		FACILITY TYPE:	840
ADDRESS:	5223 BIGELOW		TELEPHONE:	(562) 455-5226
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 28	CENSUS: 19	DATE:	11/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Director, Viridiana Munoz		TIME COMPLETED:	04:00 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 November 4, 2022 at 2:00 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Viridiana Munoz. 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 after-school program is located at Stephen Foster Elementary School. Per Director, the program operates Monday through Friday from 2:55 pm to 6:00 pm with early dismissal on Wednesday's at 1:36 pm. All areas on the facility sketch were inspected. The program provides child care inside Classrooms 73 and 76, and utilize the gated outdoor play yard on the school campus. Upon arrival, the Director and Staff (S1) were present with 9 children in classroom 76, and Staff (S2) was present with 10 children outside. 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), and Daily Activity Schedule. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Sinks and toilets were inspected for availability and good repair. General sanitation was observed. Per Director, the isolation area is located in a designated area inside Classroom 76, and the staff restroom is available if an ill child requires it. Availability of indoor and outdoor drinking water was observed (water jugs and drinking fountains).

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 STEPHEN FOSTER STATE SA SITE	FACILITY NUMBER: 198015310
	VISIT DATE: 11/04/2022

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
26
27
28
29
30
31
32

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. The facility provides the children with snacks daily. Snacks are prepared by the Bellflower Unified School District. Per Director, no meals are prepared or served at the facility. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair.

Smoke detector and carbon monoxide detector were tested and are operable. The fire extinguisher is fully charged and was last serviced on August 11, 2022. The facility has verification of disaster and fire drills. The last drill was conducted on October 18, 2022. First Aid supplies were observed and kept in each classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note. At this time, there are no children enrolled requiring medication. This facility does not provide transportation.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 a record review of five (5) children’s records and three (3) personnel records for completeness. Based on the children's record review, children's records were complete with all the required documents per licensing regulations. Based on the personnel record review, Staff (S1) did not have the Mandated Reporter Training (AB 1207) available for review. The names of children and staff whose records were reviewed were documented. 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.

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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 STEPHEN FOSTER STATE SA SITE	FACILITY NUMBER: 198015310
	VISIT DATE: 11/04/2022

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
26
27
28
29
30
31
32

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.

Deficiency was 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, Viridiana Munoz.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 11/04/2022 03:30 PM - It Cannot Be Edited

Created By: Monique Ayala On 11/04/2022 at 03:07 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 STEPHEN FOSTER STATE SA SITE	FACILITY NUMBER: 198015310
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/04/2022

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 personnel record (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/05/2022
	Plan of Correction
1 2 3 4	Staff (S1) will complete the Mandated Reporter Training (AB 1207), and the facility will submit proof of completion to LPA via e-mail by December 5, 2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Monique Ayala

LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4