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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191608844
Report Date: 04/04/2023
Date Signed: 04/04/2023 05:47:01 PM

Document Has Been Signed on 04/04/2023 05:47 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITEFACILITY NUMBER:
191608844
ADMINISTRATOR:EVELYN GARIBAYFACILITY TYPE:
840
ADDRESS:5206 BRIERCRESTTELEPHONE:
(562) 925-6493
CITY:LAKEWWODSTATE: CAZIP CODE:
90713
CAPACITY: 56TOTAL ENROLLED CHILDREN: 102CENSUS: 35DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Director, Janesa SmithTIME COMPLETED:
06:00 PM
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On April 4, 2023 at 1:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Janesa Smith. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is currently licensed for 56 children, ages 4.5 thru 12 years old. The before and after-school program is located at Gompers K-8 School. Per Director, the program operates Monday through Friday from 6:30 am to 9:00 am, and 1:00 pm to 6:00 pm.

All areas on the facility sketch were inspected. The program provides child care inside the school Cafeteria and utilize the gated outdoor play yard on the campus. Upon arrival, the Director, two (2) Teacher Aides, and thirty-five (35) children were present. LPA was informed that parents sign their children out during pick-up while staff sign the children in as soon as they arrive to the program. Sign-in sheets were reviewed; all children present were signed in.

The following documents are posted in a prominent, publicly accessible area at the facility: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (PUB 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), Daily Activity Schedule, Earthquake Preparedness (LIC 9148), and Verification of Disaster and Fire Drills. The last drill was conducted on March 10, 2023.

Furniture and equipment were inspected for age appropriateness and good repair. LPA did not observe storage space available for children to place their belongings. Children's backpacks, jackets, and personal belongings were all placed on the floor inside the cafeteria. Telephone service, heating, lighting and ventilation were evaluated. Sinks and toilets were inspected for availability and good repair. General sanitation was observed. Per Director, the children utilize the restrooms that are located in the cafeteria and auditorium.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 04/04/2023
NARRATIVE
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Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. The facility provides the children with snacks daily. Per Director, no meals are prepared or served at the facility.
All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair.

Per Director, the isolation area is located in the staff area inside the cafeteria. Per Director, if an ill child requires the restroom, the staff restroom in the auditorium is available for use. There was no napping equipment to be inspected. Availability of indoor drinking water was observed in the cafeteria (water jug and disposable cups). Per Director, the children do not use the drinking fountains located on the school premises while in care. Per Director, lead testing has not been completed at the facility as the facility is waiting on the school district for the lead testing report.

The facility has a carbon monoxide detector that was tested and is operable. Smoke detectors were not tested during this visit due to the smoke detectors being wired to the emergency pull down fire alarm. The fire extinguisher is fully charged and was last serviced on December 9, 2022.

First Aid supplies were observed and kept in the cafeteria. According to the Director, medication is only administered to a child when accompanied with a doctor's note. At this time, no children enrolled require medication. Per Director, transportation is provided by the facility and the vehicles used have the proper seat restraints for children.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 04/04/2023
NARRATIVE
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LPA conducted a record review of six (6) children’s records and two (2) personnel records for completeness. 1 out of 6 children had an incomplete record per licensing regulations. Child (C4) did not have the following documents available for review: Personal Rights (LIC 613A) and Notification of Parents' Rights (LIC 995). Based on record review, C4 had an electronically signed copy of required documents. LPA advised the Director that electronic copies of children's records should be clear on what the authorized representative is acknowledging and signing for, including the Admission Agreement and Consent for Emergency Medical Services.

Based on the personnel record review, the Director did not have a certificate of completion for the Preventative Health and Safety Practices training (EMSA-approved). One (1) Teacher Aide (S3) that was present upon arrival did not have a record available for review. Based on further review and telephone interview with Program Manager, Jessica Quintero. S3 was not cleared to work and does not have the required criminal record clearances or exemption. Per Director, S3 started working at the facility sometime in March. The names of children and staff whose records were reviewed were documented. There is at least one person trained in CPR and Pediatric First Aid present during this visit.

Director was reminded 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. A civil penalty was assessed due to this regulation being violated.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 04/04/2023
NARRATIVE
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Deficiencies were cited and a civil penalty was assessed during today's inspection (refer to deficiency pages). Acknowledgement of Receipt of Licensing Reports (LIC 9224) was provided. A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

During the inspection, LPA discussed the Technical Support Program (TSP) via telephone with Program Manager, Jessica Quintero, who agreed to participate in the program. A flyer regarding TSP was provided to the Director.

Exit interview was conducted and report was reviewed with Director, Janesa Smith. Appeal Rights were discussed, and a copy was provided to the facility representative.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2023 05:47 PM - It Cannot Be Edited


Created By: Monique Ayala On 04/04/2023 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(d)
Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 3 personnel (S3) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2023
Plan of Correction
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Teacher Aide (S3) left the facility as soon as confirmation was received that the staff was not cleared to work at the facility, and did not have the required criminal record clearances. S3 will not return to work until the required criminal record clearances or exemption is granted. Civil penalty was assessed.
Type A
Section Cited
CCR
101516.5(b)
Teacher-Child Ratio
(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the facility only had the Director and 1 qualified Teacher Aide with 35 children upon arrival which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2023
Plan of Correction
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As more children arrived to the facility, more personnel arrived to provide care and supervision. Per Director, the facility will remain in compliance with staffing ratio.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/04/2023 05:47 PM - It Cannot Be Edited


Created By: Monique Ayala On 04/04/2023 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above as the Director confirmed that the facility has not completed the lead testing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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Facility will complete the required lead testing or obtain a copy of the lead testing report from the school district and submit the lead testing results to the Water Board by May 4th.
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the Director did not have the Preventative Health and Safety Practices certificate of completion (EMSA-approved) available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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Director will complete the required Preventative Health and Safety Practices (EMSA-approved) training and submit proof of completion to the Monterey Park Child Care Regional Office via mail by May 4th.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 04/04/2023 05:47 PM - It Cannot Be Edited


Created By: Monique Ayala On 04/04/2023 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.2(e)
Teacher Aide Qualifications and Duties
(e) An aide shall work only under the direct supervision of a teacher.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above as the facility did not have a teacher present and only had the Director and 1 qualified Teacher Aide upon arrival while 35 children were observed in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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The licensee will train all staff, including the Director and Program Manager of the Teacher Aide Qualifications and Duties as well as staffing ratios. The facility will submit to the Department the training material as well as a sign-in sheet for the training to the Monterey Park Child Care Regional Office via mail by May 4th.
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 out 3 personnel (S3) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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2
3
4
One Teacher Aide (S3) did not have a record available for review during the inspection. During the inspection, LPA was notified that S3 was not cleared to work at the facility. The facility will obtain the required personnel record for S3 and submit proof of completion to the Monterey Park Child Care Regional Office via mail by May 4th.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 04/04/2023 05:47 PM - It Cannot Be Edited


Created By: Monique Ayala On 04/04/2023 at 04:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(b)(1)
(1) The center shall give each authorized representative a copy of the Personal Rights for (LIC 613A).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 6 children's records (C4) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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2
3
4
Facility will obtain a completed LIC 613A for Child (C4) and submit proof of completion to the Monterey Park Child Care Regional Office via mail by May 4th.
Type B
Section Cited
CCR
101238.4(a)
(a) The licensee shall ensure that each child has an individual permanente or portable storage space for his/her clothing, personal belongings and/or bedding.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as the facility did not have storage space available for the children's belongings which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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2
3
4
The facility will have individual permanent or portable storage space made available for children to store their personal belongings, and will submit proof of completion (photograph) to the Monterey Park Child Care Regional Office via mail by May 4th.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


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