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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020671
Report Date: 08/03/2022
Date Signed: 08/03/2022 05:13:04 PM

Document Has Been Signed on 08/03/2022 05:13 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA OF GREATER WHITTIER - INFANTFACILITY NUMBER:
198020671
ADMINISTRATOR:NICOLE RODRIGUEZFACILITY TYPE:
830
ADDRESS:12510 HADLEY ST.TELEPHONE:
(562) 551-1972
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY: 10TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Director, Nicole RodriguezTIME COMPLETED:
05:20 PM
NARRATIVE
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On 8/3/22 Licensing Program Analyst (LPA) Lilli Babcock visited facility to conducted a complaint inspection for the preschool and school-age licenses. A COVID risk assessment was conducted, and appropriate PPE was used by LPA.

At 7:37 am LPA arrived at facility and attempted to locate the Director. LPA noticed an open classroom door at the end of the hall. LPA observed Staff #1 alone with 15 school-age children in the School-age One Classroom. LPA then walked by another classroom (infant room) and observed Staff #2 alone with 5 infants. LPA located Director, Nicole Rodriguez, in the Preschool Two Classroom with 5 preschool children. LPA explained to director that infant room was out of ratio.

Based on the LPAs observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.


LPA Lilli Babcock informed facility representative, Nicole Rodriguez that this report dated 8/3/2022 document(s) (number of Type A citation) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.Also, LPA Lilli Babcock informed the facility representative to provide a copy of this licensing report dated 8/3/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview conducted and report was reviewed with Director, Nicole Rodriguez.

Page 1 of 1 End of Report

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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Document Has Been Signed on 08/03/2022 05:13 PM - It Cannot Be Edited


Created By: Lilli Babcock On 08/03/2022 at 04:57 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA OF GREATER WHITTIER - INFANT
FACILITY NUMBER: 198020671

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2022
Section Cited
CCR
101416.5(b)

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101416.5(b) Staff-Infant Ratio
There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not med as evidenced by:
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Director will ensure that staff-infant ratio is met in the future.
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Based on LPA observstion of 1 teacher caring for 5 infants, the director did not ensure that staff-infant ratio was met in 1 of 1 infant classroom, which poses an immediate health and safety risk to persons in care.
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Lilli Babcock
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
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