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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016279
Report Date: 10/31/2024
Date Signed: 10/31/2024 10:06:58 AM

Document Has Been Signed on 10/31/2024 10:06 AM - 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:
10/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Program Coordinator, Giselle BironesTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On October 31, 2024, Licensing Program Analyst (LPA) Keneisha Dunlap conducted an unannounced Case Management visit to amend the 809 & 809D report issued on 08/30/24. LPA Dunlap met with Program Coordinator, Giselle Birones. This is a school-age program that operates at 6:30am to 6:00pm Monday-Friday. Transportation services are provided. There were no children in care during visit.


LPA Dunlap reviewed amended 809 & 809D report with licensee and provided a copy of the amended report. LPA Dunlap collected wet signature on the 809 & 809D dated 08/30/24.

The Notice of Site Visit was provided.

Exit interview was conducted with Program Coordinator, Giselle Birones and a copy of this report was provided with appeal right.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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