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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400660
Report Date: 01/31/2023
Date Signed: 01/31/2023 02:12:09 PM

Document Has Been Signed on 01/31/2023 02:12 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA OF GLB NIETO HERRERA ELEMENTARYFACILITY NUMBER:
198400660
ADMINISTRATOR:BRITTAIN, SAMMYFACILITY TYPE:
840
ADDRESS:1620 TEMPLE AVENUETELEPHONE:
(562) 279-1623
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 0DATE:
01/31/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michele Janssen, ApplicantTIME COMPLETED:
12:15 PM
NARRATIVE
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On Tuesday, January 31, 2023 at 10:00 a.m., LPA Mayra Rivera conducted an office meeting with Applicant Michele Janssen, in regards overview of the pending documents. During the meeting, LPA Rivera explained which documents need to be corrected and which documents are still pending. During the visit, applicant completed and updated forms LIC 200A Application for Child Care Center, LIC 308 Designation of Administrative Responsibility, LIC 309 Administrative Organization, LIC 401 Monthly Operating Statement, LIC 500 Personnel Summary Report, Job descriptions for Director, Teacher and Teacher assistant, Employee Handbook, Parent Handbook , LIC 610 Emergency Disaster Plan, facility sketch, p.m. and snack menu. During the meeting, LPA received the updated articles of incorporation and bylaws.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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