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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016279
Report Date: 10/02/2024
Date Signed: 10/02/2024 02:27:25 PM

Document Has Been Signed on 10/02/2024 02:27 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 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:
(562) 423-0491
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Program Coordinator, Giselle BironesTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On October 2, 2024, at 2:00p.m, Licensing Program Analyst (LPA’s) Keneisha Dunlap and Dayna Chambers conducted an unannounced case management visit. LPA Dunlap met with Program Coordinator, Giselle Birones, who guided LPA on a tour of the facility. There are 38 children enrolled, and 0 children present at the time of visit.

LPA gave printed LIC809C from previous visit on 8/30/24 to Program Coordinator, Giselle Birones. The LIC809C was missing a signature from original report on 8/30/24. Program Coordinator signed report and made a copy of the document for their records.

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

Notice of visit given and must be posted for 30 days.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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