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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418587
Report Date: 03/26/2025
Date Signed: 03/26/2025 08:11:01 PM

Document Has Been Signed on 03/26/2025 08:11 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YMCA OF METRO LA/NORTH VALLEY PRCSFACILITY NUMBER:
197418587
ADMINISTRATOR/
DIRECTOR:		OLIVIA REVILLAFACILITY TYPE:
840
ADDRESS:12450 MASON AVENUETELEPHONE:
(818) 425-1728
CITY:PORTER RANCHSTATE: CAZIP CODE:
91326
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 22DATE:
03/26/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:16 PM
MET WITH:Natalie Galstyan, Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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On 3/26/2025 Licensing Program Analyst (LPA)Isabel Ortega met with Facility Lead Teacher, Natalie Galstyan and conducted an Annual Inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 22 children in care and 2 staff providing care and supervision. Facility Operates on North Valley Elementary School campus, at the school library and Multi Purpose Room(MPR) are approved for before and after school care.

Facility provides morning and after school care. Monday through Friday from 6:30 a.m. to 8:30 a.m. and after school care from 2:35 p.m. to 6:30 p.m.
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed storage for children's belongings. The classroom consists of filtered water dispenser(Brita) with individual disposable cups for children during indoor care. For outdoor children utilize their own water bottles brought from home. An isolation area was inspected, which takes place in library office space. Children have the option for rest time and quiet time if needed.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY PRCS
FACILITY NUMBER: 197418587
VISIT DATE: 03/26/2025
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Age-appropriate sinks and toilets were inspected for availability, toilets flush properly. Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms are cleaned, restocked of toiletries by staff during the day and Friday deep clean is conducted with all toys, equipment, and material. Monday through Friday staff disinfect and sanitize the facility.

According to Facility, there are no bodies of water on the premises. LPA did not observe any bodies of water during this inspection. According to Facility there are no weapons nor guns at the facility. LPA did not observe any weapons or guns at the facility during inspection.
The furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and AC ventilation were evaluated. LPA observed individual storage for children's belongings.

Facility has all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, Car seat safety and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, carbon monoxide were observed to be operating properly. The fire extinguisher (2A10BC) is reading in green; the Fire extinguisher is serviced yearly(LPA observed a tag on the Fire Extinguisher).

Cleaning supplies are out of reach of children. Trash cans with tight lids were observed.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY PRCS
FACILITY NUMBER: 197418587
VISIT DATE: 03/26/2025
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Food and snacks are on site, and are properly labeled, stored, and within expiration date. Facility also, has emergency snacks available on site.

Emergency Drills are conducted every sixth month last drill was conducted and documented on 2/11/2025 at 2:35 p.m. a total of 46 children participated in the emergency drill (fire and earthquake drills completed).



The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair. During outdoor play children have access to filtered water from a water dispenser and disposable cup are available.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.

One staff is currently certified in Pediatric CPR/First Aid dated 1/21/2024 and does not expire until January 2026. Childcare Provider Mandated Reporter (AB1207) training certificate is dated 2/15/2024.

The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY PRCS
FACILITY NUMBER: 197418587
VISIT DATE: 03/26/2025
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 For IMS information see PIN 22-02-CCP. 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-carecenters/.
All staff are required to take the Child Care Provider Mandated Reporter (AB1207) training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.



For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY PRCS
FACILITY NUMBER: 197418587
VISIT DATE: 03/26/2025
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Facility is aware all staff are mandated child abuse reporters, and all suspected child abuse shall be reporter to the Child Abuse Hotline 1 (800) 422-4453.

Per Title 22 Regulations facility is complying with rules and regulation, no deficiencies will be issued today. An exit Interview was conducted with facility. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day. A copy of this report must be made available to the public for 3 years. The Notice of site visit shall be visibly posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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