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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016279
Report Date: 09/04/2025
Date Signed: 09/05/2025 09:38:57 AM

Document Has Been Signed on 09/05/2025 09:38 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:
09/04/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Facility Reprentative- Jesse Ramos Shyman TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Amended report as of 9/5/25. Line 6 Pg5, On September 4, 2025, at 11:25 AM, Licensing Program Analyst (LPA) Keneisha Dunlap conducted an unannounced annual inspection. Facility Representative -Jesse Ramos Shyman granted entry after LPA Dunlap announced the purpose of the visit. At the time of inspection, 33 children were enrolled, with 0 children present, along with 2 staff members. This is an afterschool program operating Monday through Friday, from 6:30 AM to 8:00 AM. & 2:30 PM to 6:00PM.

LPA Dunlap confirmed all required operational postings were present on the licensing board, including: LIC 203A (License), LIC 610, PUB 393, PUB 269, LIC 9148, LIC 613A, Menus, and the Activity Schedule.

Classrooms are equipped with age-appropriate furniture and learning materials, including a carpeted area, sink, soft furnishings, age-appropriate toys, and age-appropriate chairs & tables. All classroom equipment and materials were observed to be in good condition, free of sharp, loose, or pointed parts.

Boys and Girls Bathrooms were observed to be in good and operable condition, equipped with age-appropriate sink, and toilets.

Water Source: A portable bottom loading water dispenser is available in the classroom. This dispenser is also used during outdoor play. The children use disposable cups for drinking. There is also a water fountain located in classroom 1.

All cleaning supplies and/or hazardous materials are stored in a locked key closet, making them inaccessible to children.

Playground Area: This area features a shaded structure with artificial grass, age-appropriate toys, a slide structure, and age-appropriate picnic tables. The playground area and materials were observed to be in good condition, free of sharp, loose, or pointed parts. Page 1 of 5

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
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 FAIRFIELD FAMILY SITE
FACILITY NUMBER: 198016279
VISIT DATE: 09/04/2025
NARRATIVE
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At 11:45 AM, LPA Dunlap observed cobwebs throughout the playground area. The Facility Representative was informed that the building grounds must be kept clean to ensure the health and safety of the children, as this poses a potential health and safety risk. The Facility Representative stated that they would have staff clean the area. Technical Assistant will be cited.

The facility has a storage area where there is a refrigerator, and dry and canned goods are stored. There is a vendor that provides snacks and lunch for the facility. All food items are already prepared with the vendor. Prepacked snacks have labels with date.

Documentation of current Fire and Earthquake drills was observed, with the last drill conducted on March 7, 2025.

Fire extinguisher(s) were observed with a service tag date of May 20, 2025.

The facility has an operable pull down fire alarm.

Operable dual smoke and carbon monoxide detectors were observed.

All electrical outlets throughout the facility are covered.

All trash cans have lids.

The Facility Representative confirmed no firearms are present at the facility.

There are large bodies of water on the premises. Made off limits by a gate and only the maintenance technician has access to the gate.

The office serves as an isolation area for sick children.

The Facility Representative confirmed they administer medication. Medications administered to children are kept in a locked cabinet in the main office, inaccessible to children.

The facility uses a landline for communication but also has a cellphone as well.

The facility was reminded that smoking is prohibited on the premises.

The facility does provide transportation for children.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: 09/04/2025
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No sign in and out sheets were checked since there were no children present at the time of inspection.

Staff Files



Staff #1's file contains all required licensing documents and their immunization record.

CPR certification expires on June 6, 2027.

Mandated Reporter training expires on August 17, 2026.

Accredited courses in file.

Staff #2's file contains all required licensing documents and their immunization record.

CPR certification expires on June 6, 2027.

Mandated Reporter training expires on September 12, 2025.

Preventative Health & Safety (Lead & Nutrition) Certificate

Accredited courses in file.

At 12:35 PM, During a record review, LPA Dunlap noted that while Staff #1 did have a picture of their immunization records in the file that it was not legible (blurred) for review. The Facility Representative was informed that they needed to obtain an actual copy of the immunization record. Staff # 2 did not have all immunization record in their file. The Facility Representative was informed that they did not have a copy of all of the immunization records. The facility was able to provide a copy during the time of the inspection. This poses a potential health and safety risk to children. Technical Assistant will be cited.

Children Files

Child #1's file contains all required licensing forms, and their immunization record.

Child #2's file contains all required licensing forms, and their immunization record.

Child #3's file contains all required licensing forms, and their immunization record.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: 09/04/2025
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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.

Criminal Record Clearance - Child Care Centers- Facility Representative -Jesse Ramos Shyman 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.

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.

CCC TESTING DEADLINE HAS NOT PAST

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

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 (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/.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: 09/04/2025
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Facility Representative -Jesse Ramos Shyman 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.

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

2 Technical Assistance cited during today’s visit.

Appeal rights reviewed and given to the Facility Representative -Jesse Ramos Shyman.

Exit interview conducted and report was reviewed with the Facility Representative -Jesse Ramos Shyman.

Page 5 of 5

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Keneisha Dunlap
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8