198015658-6-16-2023-54-CC-AMOY-CSV47X-20230616185152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015658
Report Date: 06/16/2023
Date Signed: 06/16/2023 06:51:59 PM

Document Has Been Signed on 06/16/2023 06:51 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:	UNION PACIFIC CDC/YWCA OF GREATER L.A.		FACILITY NUMBER:	198015658
ADMINISTRATOR:	NORMA GONZALEZ		FACILITY TYPE:	830
ADDRESS:	4315 UNION PACIFIC AVENUE		TELEPHONE:	(323) 415-6057
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY: 38	TOTAL ENROLLED CHILDREN: 28	CENSUS: 23	DATE:	06/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Adriana Velazco, Site Director		TIME COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Alicia Mooberry and Rosaura Valenzuela conducted an unannounced Annual inspection. LPAs met with Adriana Velazco, Site Director, explained the purpose of the inspection and provided the Entrance Checklist, LIC 125. LPAs toured the facility. The facility operates Monday thru Friday from 7:00 AM-5:30 PM and provides care for Infants from birth - age two (2), with a toddler option that provides care for toddlers age 18 months - 30 months. There is a pre-school license # 198015657 that shares the building that operates separately. There are two classrooms: Toddler and Infant.

Upon arrival LPA observed 10 infants and 3 staff in the Infant Room and 13 Toddlers and 3 staff in the outdoor play area. Facility operation hours are Monday to Friday from 7:00 AM to 5:30 PM.

All staff have obtained background clearance. LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Parent’s Rights.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log. Disaster drill was discussed. Sign in and out sheets were reviewed. The Site Director was reminded to ensure that person who signs the child in and out uses their full legal signature and record the time of the day. All children present were signed in. Current menus were observed in each classroom.

Indoor space is physically separate from other child care component. Furniture and equipment were inspected for age appropriateness and good repair. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA did not observe any baby walkers or any items that fall into that category present in the facility. Telephone service, heating, lighting and ventilation were evaluated and are functioning properly.

Page 1-Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: UNION PACIFIC CDC/YWCA OF GREATER L.A.	FACILITY NUMBER: 198015658
	VISIT DATE: 06/16/2023

NARRATIVE

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Age appropriate sinks, toilets and potty chairs were inspected for availability, good repair, water temperature, area safety and sanitation. Changing table has raised sides at least three inches high and is within an arms reach of a hand washing sink. Toys observed to be clean. There are bathrooms in the Toddler room and a changing table in an adjacent room. LPA observed that there was a whole about two inches in diameter on the wall behind the toilet in the toddler room posing a potential risk to the safety of children in care (photo taken)

A first aid kit is kept inside the classroom. The fire extinguisher was observed to be service tag and carbon monoxide detectors were observed in each classroom. There is a sprinkle system attached to the smoke alarm. Storage cabinet in classrooms was locked and hazardous items including cleaning compounds were stored inaccessible to children. Medication was observed to be stored and labeled in the refrigerator in the Infant room.

The facility has completed the required Lead Testing of faucets used for drinking and food preparation on 08/20/22.

All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean.

Telephone service, heating, lighting and ventilation were evaluated and are in operating condition. Per Assistant Director, the isolation area is located in a room next to the office where child will be supervised until they are picked up by parents. Parents are contacted immediately when children are determined to be ill.

Director states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock.

All kitchen areas/food preparation areas 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, including moveable bins have tight-fitting covers that are kept on, and in good repair.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides AM snack, lunch and PM snack for children who eat table food. Bottles, dishes, and containers of food brought by the infant’s authorized representative are labeled with infant’s name and the current date. All foods/beverages are stored or refrigerated.

Page 2 Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/16/2023 06:52 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 06/16/2023 at 01:55 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: UNION PACIFIC CDC/YWCA OF GREATER L.A.	FACILITY NUMBER: 198015658
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in that there was a hole in the wall behind one of the toddler toilets which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/23/2023
	Plan of Correction
1 2 3 4	The whole was covered with tape temporarily, a work order was placed for the whole to be patched. Per Site Director, proof of correction will be submitted to LPA via email by POC due date.

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:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: UNION PACIFIC CDC/YWCA OF GREATER L.A.	FACILITY NUMBER: 198015658
	VISIT DATE: 06/16/2023

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Staff records were reviewed. LPA observed Staff required units, Current Pediatric first aid and CPR, immunization's, Mandated Reporter training and health screening on file.

Children’s Records were reviewed to ensure that Identification and Emergency, Needs and Services Plan, and LIC 9227- Infant Sleep Plan (0-12 months) are on file. There is a designated infant napping area with enough cribs and mats for every child enrolled. Children have their own cubby to store their belongings. Cribs were observed to be free of loose articles and objects including blankets and pillows. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. During this visit children were observed to be under visual supervision of a teacher at all times.

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/inspection-process.

The Site Director was reminded that all adults 18 and older working in the facility, 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 licensed facility. 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 discussed the safe sleep regulations with Assistant Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Assistant Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following deficiencies are being cited in accordance to Title 22 Regulations (See LIC 809D).

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

Exit interview conducted and report was reviewed with Adriana Velazco, Site Director.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

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