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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016279
Report Date: 08/30/2024
Date Signed: 10/28/2024 02:08:33 PM

Document Has Been Signed on 10/28/2024 02:08 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 FAIRFIELD FAMILY SITEFACILITY NUMBER:
198016279
ADMINISTRATOR/
DIRECTOR:		ANGELICA CORTEZFACILITY TYPE:
840
ADDRESS:4949 ATLANTIC AVENUETELEPHONE:
5624230491
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: DATE:
08/30/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Amended report as of 10/28/24. Line(s) 17, 23 on Page 2 and Line(s) 5, 11, 12, 18 on Page 3 have been removed (amended). Licensing Program Analysts (LPA’s) Keneisha Dunlap and Franchesca White conducted an unannounced Annual Random inspection. LPA met with Program Coordinator, Giselle Birones who provided a tour of the facility. This is a school-age program that operates at 6:30am to 6:00pm and then resumes care from 6:30a.m. - 6:30pm Monday-Friday. Transportation services are provided. Program Coordinator indicated there is no summer care. The facility is on Summer Break at this time.

The school age program operates on a YMCA site that is also open to the public however, the program and outdoor play yard is separate. Children and parents enter the facility through the front entrance and sign in at the classroom. LPA's inspected three school age classrooms, storage room, two restrooms and the school age play yard. LPA observed signs posted indicating the restrooms are to be used by the school age program only. All areas appear to be free of hazards.

Furniture and equipment was inspected for age appropriateness and good repair free of sharp, loose, or pointed parts. Floors are clean and safe. Disinfectants, cleaning solutions are kept in a storage room inaccessible to children. The primary lighting source is overhead lighting. The facility has central air/heating. Electrical outlets are covered in the classrooms. There are drinking containers in the classrooms for children to drink as they wish.

Restrooms are gender specific clean and odor free. There is an adequate supply of toilet paper, paper towels, and soap. All restroom fixtures are height appropriate for children. Staff have their own restroom located to the right of the office. The facility serves PM Snack at 3:00pm and snacks are delivered by an outside vendor. There is a refrigerator in a storage area where

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 08/30/2024
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refrigerated milk is kept. Menus were reviewed. Trash bins to discard food have tight fitting lids.

Outdoor activity play area is comprised of cement and astro turf cushioning material, which surrounds the climbing equipment. During outdoor activities, and a water fountain



Fire drill log- 7/23/24
Earthquake drill log-8/12/24
Carbon Monoxide Detector operable
Fire System operable

Staff Files:

Staff #1
  • File has all required licensing forms
  • Mandated Child Abuse Reporter- Expiration 8/29/26
  • CPR & First Aid- 3/25/25

Staff #2
File has all required licensing forms
  • Mandated Child Abuse Reporter- Expiration 9/24/24
  • CPR & First Aid- 6/15/26


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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 08/30/2024
NARRATIVE
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Staff #3
File has all required licensing forms
  • Mandated Child Abuse Reporter- Expiration 10/23/25
  • CPR & First Aid- 3/25/25

Staff #4
File has all required licensing forms
  • Mandated Child Abuse Reporter- Expiration 8/21/25
  • CPR & First Aid- 2/21/26

Staff # 5
  • File has all required licensing forms
  • Mandated Child Abuse Reporter- Expiration 8/15/25
  • CPR & First Aid- 3/25/25


Children Files

Child #1
  • File has all required licensing forms

Child #2
  • File has all required licensing forms

Child #3
  • File has all required licensing forms

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 08/30/2024
NARRATIVE
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Child #4
  • File has all required licensing forms

Child #5
  • File has all required licensing forms

The Program Coordinator stated that they communicate with parents via text, phone, and/or person. The Licensee has a cell phone that they use.

The Program Coordinator stated they do not have any children that they administer medication to at this time. If children were to have medications that need to be administered there is a lockbox in the locked storage cabinet.

The Program Coordinator stated that when children are sick they are kept in office.

The Program Coordinator stated there are no firearms on the premises.

The Program Coordinator stated that there are no smokers inside or around facility.

The Program Coordinator stated that they provide transportation for children in the AM & PM for drop off and pick up at school.

The Program Coordinator stated that have any children with allergies are listed in Directors office and given a food substitution.

The Program Coordinator stated that the discipline policy is redirection for children in care, and to send parents home report on children's behavior. If behavior continues there will be a meeting with parents. .

The Program Coordinator stated that does have first aid kit.
The Program Coordinator stated that they provide annual staff training's regarding communication and professionalism.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 08/30/2024
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The facility does have a pool area that is inaccessible to children in care. The gate meets the minimum requirement. The area is only accessible through a door on the other other side of facility near fitness area.

Lead Testing

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred Program Coordinator, Giselle Birones to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS)

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 08/30/2024
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(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-carecenters/. IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: 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/.

MyChildCarePlan.org

Program Coordinator, Giselle Birones 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. Megan’s Law - Family Child Care Homes During the exit interview, the LICENSEE ****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a civil penalty of $100 per day.

Exit interview conducted and report was reviewed with the Program Coordinator, Giselle Birones

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2024 02:06 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/28/2024 02:05 PM


Created By: Keneisha Dunlap On 08/30/2024 at 01:04 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Amended on 10/28/24- Based on record review, the licensee did with the section cited above files are have required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2024
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024


LIC809 (FAS) - (06/04)
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