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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015673
Report Date: 05/30/2025
Date Signed: 05/30/2025 04:14:57 PM

Document Has Been Signed on 05/30/2025 04:14 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA GLB INTENSIVE LEARNING CENTER SITEFACILITY NUMBER:
198015673
ADMINISTRATOR/
DIRECTOR:		ADRIANA MENDOZAFACILITY TYPE:
840
ADDRESS:4718 MICHELSON STREETTELEPHONE:
(562) 233-7748
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 100TOTAL ENROLLED CHILDREN: 29CENSUS: 23DATE:
05/30/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Director, Adriana MendozaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On May 30, 2025, at 1:30pm, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced inspection at the facility noted above and met with Facility Representative, Adrian Mendoza. The purpose of the inspection was to conduct a case management annual continuation inspection at the facility. The facility is currently licensed for 100 school-age children. The after-school program is located at Intensive Learning Center. Per Facility Representative, the program operates Monday through Friday from 2:30 pm to 6:00 pm with early dismissal on Wednesday's at 1:06 pm. Present at the time of today’s inspection were facility representative, two staff, and 23 children.

This report reflects information collected on 03/10/2025, 05/07/2025, and 05/30/2025.

Children utilize different areas of the campus. The program is licensed to provide childcare inside Classrooms 80, 81, and 85. Per facility Representative, classroom 81 is the only classroom currently in use. Children also utilize the school’s playground for outdoor play, cafeteria, and two nearby single stall and sink restrooms.



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. Telephone service, heating, lighting and ventilation were evaluated. Sinks and toilets were inspected for availability and good
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB INTENSIVE LEARNING CENTER SITE
FACILITY NUMBER: 198015673
VISIT DATE: 05/30/2025
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repair. General sanitation was observed. There was no napping equipment to be inspected. Per Facility Representative, the isolation area is in the staff lounge which has a restroom that may be used if an ill child requires it. Availability of indoor drinking water was observed inside the classroom via water dispenser. Per Facility Representative, five-gallon bottles of water are ordered and delivered when needed. LPA observed eight full five-gallon bottles of water.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children. Facility Representative confirmed that there are no poisons stored at the facility. Representative was reminded that if poisons are purchased, they are to be stored in an area that is locked and inaccessible to children. Per Facility Representative, there are no bodies of water on the premises.



The facility provides snacks. Snacks are prepared by the Bellflower Unified School District. Per Facility Representative, no meals are prepared at the facility. LPA observed that snacks are packaged and stored in the school’s cafeteria until distributed to the children.

LPA observed safety equipment. The facility has a combination smoke and carbon monoxide detector that was tested and is operable. Fire extinguisher is fully charged and was last serviced on July 29, 2024. The facility has verification of disaster and fire drills. The last drill was conducted on 03/25/2025. First Aid supplies were observed and are kept in the classroom. According to the Facility Representative, medication is only administered to a child when accompanied with a doctor's note. At this time, there are no children enrolled requiring medication.

LPA conducted a file review of three staff files and one child file. During record review, LPA observed that staff and child files were not complete with all of licensing forms. Per Facility Representative, completed files are held at their main facility. LPA observed that some of the information provided inside of files is the same information The Department requires on licensing forms. Facility Representative has current American Red Cross Adult CPR/AED Pediatric CPR and First Aid expires on 03/17/2027 and Mandated Reporter Completion dated 05//09/2025. All staff file has proof immunization and valid mandated reporter certificates.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB INTENSIVE LEARNING CENTER SITE
FACILITY NUMBER: 198015673
VISIT DATE: 05/30/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA referred Facility Representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were cited during today’s visit.

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

Exit interview conducted and report was reviewed with the Director, Adriana Mendoza.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC809 (FAS) - (06/04)
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