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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021181
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:44:59 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/11/2024 11:44 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA OF WEST SAN GABRIEL VALLEYFACILITY NUMBER:
198021181
ADMINISTRATOR/
DIRECTOR:
GOMEZ, VALARIEFACILITY TYPE:
840
ADDRESS:401 W CORTO STTELEPHONE:
(626) 576-0226
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Valerie Gomez, CEO TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On December 11, 2024, Licensing Program Analysts (LPAs) Staicy Perry and Monica Ruiz conducted an unannounced annual inspection and met with Valerie Gomez, CEO who took guided LPAs on a tour of the facility.

This is a school age program that serves children ages 5 to 13 years old. Waiver is on file for the school age children to share one of their 2 bathrooms (girl’s bathroom that consists of 3 toilets and 3 sinks) with the preschool program F# 198021180. This program operates Monday to Friday 7:30 a.m. – 5:30 p.m. Sign in and out takes place at the main entrance area as well as in the classrooms. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were not observed due to facility having no children currently enrolled. LPA’s observed present staff are fingerprinted cleared. Currently the facility is not operating with children and is in the process of enrolling children as soon as the grant funding from The California State Department Of Social Services.



LPA’s entered classroom 3 (school agers ). LPA’s observed 0 children and 0 staff. LPA’s observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA’s observed a cubby for children to store their personal belongings. LPA’s observed cleaning solutions stored inside the classroom cabinet with a key lock making it inaccessible for children to reach and open. LPA’s observed trash bins with a lids.

Heating, lighting, and ventilation were evaluated by LPA’s. LPA’s observed central AC/heater and vents located on the ceiling. LPA’s observed the thermostats located in classroom 1 and 2 and temperatures to be between 69-70 degrees. LPA’s observed the fire extinguishers located in hallways and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on April 5, 2024. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA OF WEST SAN GABRIEL VALLEY
FACILITY NUMBER: 198021181
VISIT DATE: 12/11/2024
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system as well as carbon monoxide detectors being hard wired. The last emergency drill was conducted has not yet been conducted due to no children being enrolled since pre-licensing visit. LPA’s observed napping equipment cots to be in good condition and stored in the classrooms. First aid kit supplies are kept inside the classrooms and staff lounge and LPA’s observed the kits to be fully equipped. During this visit, per CEO, stated currently has no children with medication or severe food allergies. LPA’s asked if there were any poisons, firearms, weapons, or bodies of water. CEO stated no firearms, weapons, no poisons nor bodies of water. LPA’s did not observe firearms or weapons, poisons, nor bodies of water. CEO Valerie stated the ill isolation area takes place in the director’s office and staff lounge and children will utilize staff restroom.

LPA’s observed restrooms and the restroom is located near the main entrance of the facility. LPA’s observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels.

LPA’s entered the outdoor play area. LPA’s observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA’s observed play structure equipment to be age appropriate for ages 5-12 years and areas around or under high climbing equipment, are cushioned with wood chips that may absorb a fall. For adequate shade, LPA’s observed a canopy. LPA’s observed the playground yard to be fenced and the side gates closed and locked with a keypad lock. LPA’s observed trash bins with tight lids. For outdoor water drinking, staff bring out water jugs and disposable cups.


This program provides breakfast, lunch, and pm snack. Meals and snacks are provided by facility. LPA’s informed CEO that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA’s observed water pitchers and disposable cups in the classrooms. LPA’s observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents. Lead testing was conducted on 9/6/23 and no lead exceedance. Facility will be providing transportation.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. Lead results were observed to be posted.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA OF WEST SAN GABRIEL VALLEY
FACILITY NUMBER: 198021181
VISIT DATE: 12/11/2024
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LPA’s did not review the children’s roster nor children’s files nor staff files due to no staff and children enrolled or employed.

LPA’s observed CEO’s Red Cross Pediatric First Aid/CPR certification dated 4/8/2024, and has proof of immunization against Pertussis, MMR, and Influenza declination. CEO has completed the mandated reporter (AB 1207) training dated 9/8/2021. CEO was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com
Items discussed during this visit:

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.



4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA OF WEST SAN GABRIEL VALLEY
FACILITY NUMBER: 198021181
VISIT DATE: 12/11/2024
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7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: 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 or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10.Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

Valerie 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 21-21.1CCP).

LPA’s verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA OF WEST SAN GABRIEL VALLEY
FACILITY NUMBER: 198021181
VISIT DATE: 12/11/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Valerie 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.

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.

Currently the facility is in compliance with Title 22 regulations and no deficiencies will be cited on this day.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with Valerie Gomez, CEO.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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