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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021181
Report Date: 09/05/2025
Date Signed: 09/05/2025 03:39:18 PM

Document Has Been Signed on 09/05/2025 03:39 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA OF WEST SAN GABRIEL VALLEYFACILITY NUMBER:
198021181
ADMINISTRATOR/
DIRECTOR:		NORMA MORENOFACILITY TYPE:
840
ADDRESS:401 W CORTO STTELEPHONE:
(626) 576-0226
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 20TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
09/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:22 PM
MET WITH:Norma Moreno, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On September 5, 2025, Licensing Program Analysts (LPA) Staicy Perry conducted an unannounced annual inspection and met with Valerie Gomez, CEO and facility director Norma Moreno and guided LPA Perry 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 Facility# 198021180. This program operates Monday to Friday 7:30 a.m. – 5:30 p.m. When schools are in session, facility provides transportation pickups from 2 schools located within Alhambra Unified school district, 2 elementary schools, Granada and Martha Baldwin Elementary Schools depending on schools’ dismissal times. Sign-in-and-out takes place at the main entrance. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were observed to be in compliance with Title 22 Regulations. LPA observed present staff are fingerprinted cleared.

LPA entered classroom 3 (school agers). LPA 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 observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored inside the classroom cabinet with a key lock making it inaccessible for children to reach and open. LPA observed trash bins with a lids.

Heating, lighting, and ventilation were evaluated by LPA. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostats located in classroom 3 and temperatures to be between 69-70 degrees. LPA observed the fire extinguishers located in hallways and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on April 17, 2025. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system as well as carbon monoxide detectors being hard wired. The last emergency drill was conducted on August 28, 2025. First aid kit supplies are kept inside the classrooms and staff lounge and LPA observed the kits to be fully equipped. During this visit, per director, stated that currently has no children with medication or severe food allergies. LPA asked if there were any poisons, firearms, weapons, or bodies of water. Director stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2025
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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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 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: 09/05/2025
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water. Director stated the ill isolation area takes place in the director’s office and staff lounge and children will utilize staff restroom.

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

LPA entered the outdoor play area. LPA 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 5-13 years and areas around or under high climbing equipment, are cushioned with wood chips that may absorb a fall. For adequate shade, LPA observed a canopy. LPA 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 children’s water bottles.

This program provides breakfast, lunch, and pm snack. Meals and snacks are provided by facility. LPA 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 observed water bottles in the classrooms. LPA 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 does provide 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.

LPA did review the children’s roster and children files and staff files due and were observed to be complete.

LPA observed Directors Red Cross Pediatric First Aid/CPR certification dated 4/8/2024, and has proof of immunization against Pertussis, MMR, and Influenza declination. Director has completed the mandated reporter (AB 1207) training on file dated 9/16/24. The Director was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com. CCLD Orientation was observed to be on file and dated January 29, 2025. The director has also completed the Basic Integrated Germ Management Training on file and dated September 26, 2025, and is accordance with the Healthy Schools Act.

Director 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.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
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: 09/05/2025
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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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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/.

Director 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 Director Norma Moreno.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC809 (FAS) - (06/04)
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