198400820-10-5-2023-54-CC-JESA-CWBQ7E-20231005115502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400820
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:55:44 AM

Document Has Been Signed on 10/05/2023 11:55 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	YMCA OF GLB KETTERING ELEMENTARY SCHOOL		FACILITY NUMBER:	198400820
ADMINISTRATOR:	JONES, KIMBERLY		FACILITY TYPE:	840
ADDRESS:	550 SILVERA AVENUE		TELEPHONE:	(562) 279-1623
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/05/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Senior Program Director Michele Janssen and Program Director Maria Olmedo		TIME COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Jeanette Estrada, Warren Birks and Anthony Padilla conducted an announced inspection at the facility noted above and met with Senior Program Director, Michele Janssen, Program Director Maria Olmeda. The purpose of the inspection was to conduct the Prelicensing inspection to evaluate the proposed space for a school age license. Applicant is seeking to provide care for 70 school-age children. The program is located at Kettering Elementary School. The proposed program will operate before school Monday through Friday from 6:30 AM to 9:00 AM and after school from 2:00 PM to 6:00 PM. On Thursdays the facility will operate after school from 1:00 PM to 6:00 PM due to the elementary school's early dismissal. This program will operate in room 23, the school's cafeteria and the school's play yard. Two separate restrooms are available for children to use. The school's auditorium will be used for special events used outside of normal everyday school activities. The facility was granted a fire clearance for Room 23 and the Cafeteria for the requested capacity on 8/3/23. Children will meet in Room 23 and they will be separated into groups based on age. All areas identified on the facility sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service (cell phone), heating, lighting and ventilation were evaluated. There are hooks available outside the classroom for children's belongings. The facility will provide children with snacks, which will be supplied by an outside vendor. Menus are provided to parents monthly. For children present in the morning, they will have access to the school's breakfast program. First Aid supplies were observed and are kept in the classroom. Staff will also have access to a first aid kit in the cafeteria. Per Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a locked medication box located in a locked storage unit in the classroom. Disinfectants, cleaning solutions, and other items that are dangerous to children are kept in a locked storage unit in the classroom. Director stated that there are no poisons stored at the facility. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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 GLB KETTERING ELEMENTARY SCHOOL	FACILITY NUMBER: 198400820
	VISIT DATE: 10/05/2023

NARRATIVE

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Per Director, the isolation area is located next to the teacher's desk in the classroom. The staff restroom is readily available if an ill child requires it and is located in the hallway on the opposite side of the Girl's restroom. Age appropriate sinks, toilets, and urinals were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was also observed (water bottles).
There is an operable combination smoke/carbon monoxide detector in the classroom and there is an operable carbon monoxide detector in the cafeteria. The facility has a hard wired fire alarm installed throughout. The fire extinguishers are fully charged and were last serviced on July 2023
Sign in and out will be in Room 23. In the morning, children will be signed in by parents and signed out by staff. In the afternoon, children will be signed in by staff and signed out by parents.

Outdoor playground equipment is 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 material that could absorb a fall. There is adequate shade in the outdoor bench area where children will have snack and do other activities. Availability of outdoor drinking water was observed (water bottles). No bodies of water were observed on the premises.

LPAs advised facility representatives that the children need to be within the direct care and supervision, including visual supervision of staff at all times. LPAs advised to have extra care and supervision when using the auditorium for special events.
Per Senior Program Director Michele Janssen, all staff associations are connected to facility 198197013. LPA J. Estrada will verify with LPM regarding this information.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 GLB KETTERING ELEMENTARY SCHOOL	FACILITY NUMBER: 198400820
	VISIT DATE: 10/05/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with Applicant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Based on measurements taken today of Room 23 and the cafeteria, and the approved fire clearance (dated 8/3/23), the maximum capacity for the proposed program would be 70 children.

The facility is required to install outlet covers throughout the cafeteria. Proof of correction to be sent to LPA Jeanette Estrada by 10/20/23.

A final review of the application will be conducted by the Department. Once licensed, the Licensee is required to adhere to the terms and limitations stated on the license.
Exit interview conducted and report was reviewed with the Applicant, Senior Program Director Michele Janssen and Program Director Maria Olmeda.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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