198400680-3-7-2023-54-CC-MRIA-CPPSD4-20230307124633

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400680
Report Date: 03/07/2023
Date Signed: 03/07/2023 12:46:45 PM

Document Has Been Signed on 03/07/2023 12:46 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 GREATER LONG BEACH		FACILITY NUMBER:	198400680
ADMINISTRATOR:	BRITTAIN, SAMMY		FACILITY TYPE:	840
ADDRESS:	1701 PETALUMA AVENUE		TELEPHONE:	5622791623
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 0	DATE:	03/07/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Michele Janssen, Senior Program Director,		TIME COMPLETED:	12:55 PM

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On Tuesday, March 7 at 10:20 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an announced inspection at the facility noted above and met with Senior Program Director, Michele Janssen and Senior Program Director, Sammy Brittain, who guided LPA Rivera on a tour of the facility. The purpose of the inspection was to conduct the pre licensing inspection. Originally, applicant was seeking to provide care for 30 school-age children and decided during visit to increase the capacity to 73 and serve children ages 4.9 to 13 years. The program is located at Tincher Preparatory Academy School. The proposed program will operate before and after school care for school-age children, Monday through Friday, morning care hours 6:30 a.m. to 9:00 a.m., and afternoon 2:00 pm to 6:00 pm. Early school dismissal is on Thursday's at 1:00 pm. This program will be operating in classroom 20 and indoor cafeteria.

Sign in and out will take place in front of classroom 20. Parent’s will sign in for a.m. drop off, and YMCA sign out. For p.m., pick up, YMCA will sign in and parent’s sign out. All areas identified on the facility sketch were toured both indoors and outdoors; measurements were taken for indoor. A fire clearance has been granted as of February 21, 2023 for 30 school age children.

At approximately 10:40 a.m. LPA entered classroom 20. LPA Rivera observed age appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age appropriate materials accessible to children. LPA observed a hand washing sink and cleaning solutions stored inside the cabinet. LPA observed the cabinet closed and locked making it inaccessible for children to open the cabinet door.

At approximately 11:03 a.m. LPA entered the outdoor playground to conduct and inspection. LPA observed the equipment to be in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with rubber material that could absorb a fall. For adequate shade, LPA observed trees. For outdoor drinking water, facility will be bringing out the 5-water gallon and disposable cups. No bodies of water were observed on the premises.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 GREATER LONG BEACH	FACILITY NUMBER: 198400680
	VISIT DATE: 03/07/2023

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At approximately 11:30 a.m., LPA entered the indoor cafeteria room and observed the cafeteria to be clean, free of litter, rubbish, rodents, and/or any other vermin. LPA observed the indoor cafeteria to be in good condition. Side doors in the cafeteria that lead to the auditorium and the kitchen will be closed and locked during the child care hours.

The program will provide moveable storage carts or wall hooks to store the children's belongings, such as backpacks and lunch bags. Restrooms are in the hallway and outside between the classroom 20 and cafeteria. LPA Rivera observed the gender restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. Per director, Long Beach Unified School District will be providing the trash bins with tight-fitting lids to discard solid waste.

Heating lighting and ventilation were evaluated by LPA Rivera. LPA observed the heater vents located by the windows. LPA observed the fire extinguisher located in the hallway, cafeteria and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on 07/25/2022. LPA Rivera observed a carbon detector in the classroom and cafeteria; tested and heard the sound. Carbon detectors are operable. LPA also observed the first aid kit in the classroom and fully stocked. The medication will be stored in classroom 20 inside the storage cabinet.

This program will provide p.m. snack and p.m. meal and provided by an outside vendor. For water drinking LPA observed a 5-water gallon for indoor and program will provide disposable water cups. 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 moveable 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.

Director Michele has proof of pediatric First Aid/CPR certification dated 9/8/22, preventative health and safety training with the nutrition 7/28/16 and lead dated 10/21/21, child abused mandated certification (AB 1207) dated 2/8/22 and immunization against pertussis, and measles, and influenza declination. Director has been informed mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA OF GREATER LONG BEACH	FACILITY NUMBER: 198400680
	VISIT DATE: 03/07/2023

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Items discussed during this visit:

1.The following items are an immediate citation and civil penalty 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 child day care 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 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.
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 pertussis, measles, influenza or decline influenza

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.Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. (An IMS Plan was provided with the application and will be reviewed).
11.Liability insurance was also discussed.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA OF GREATER LONG BEACH	FACILITY NUMBER: 198400680
	VISIT DATE: 03/07/2023

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12.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Criminal Record Statement

Senior program director Michele was informed that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Based on measurements taken during today's inspection and sinks availability the facility is equipped for 73 school-age children. LPA will resubmit from STD 850 to fire inspector Ben Rosen to update the fire clearance to reflect the change from 30 to 73 school age children.

Per Senior program director Michele Janssen, all staff will be associated to master file YMCA Greater Long Beach-Los Cerritos 198017013.

Exit interview was conducted with Senior Program Director Michele Janssen,

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

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