<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495037
Report Date: 04/05/2022
Date Signed: 04/05/2022 11:38:29 AM

Document Has Been Signed on 04/05/2022 11:38 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:YMCA OF METRO LA/NORTH VALLEY TOPEKAFACILITY NUMBER:
197495037
ADMINISTRATOR:JACQUELINE QUINTEROFACILITY TYPE:
840
ADDRESS:9815 TOPEKA DRIVETELEPHONE:
(562) 774-5030
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/05/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Vice President, Youth Development, Christopher Jefferson, Claudia Carmona, Senior Program Director, and Jacqueline Quintero, Director. TIME COMPLETED:
11:50 AM
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
On 4/05/2022 at 8:33 a.m. Licensing Program Analysts (LPAs) Deborah Lowe and Suzette Ornelas met with Vice President, Youth Development, Christopher Jefferson, Claudia Carmona, Senior Program Director, and Jacqueline Quintero, Director. The purpose of the visit was an announce pre-licensing inspection at the facility to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. There were no children with YMCA present during this inspection. This is an application for 42 school age children, ages 4.9 years to 14 years old.

The child care center will operate a Before and After School Age program Monday – Friday 6:30 am – 8:00 am and 2:28 pm – 6:30 pm. YMCA will operate early on minimum 12:33 pm days and short dismissal 1:28 pm days. Full-Day on non-school days will only occur at the request of Topeka Drive Elementary School the hours will be 6:30 a.m. – 6:30 p.m. The fire clearance was approved on 2/10/2022. Due to a change in originally requested hours a new fire clearance will be needed.

LPAs Lowe and Ornelas toured the on-limits areas and classroom located at the facility. The facility has a total of 1 designated classrooms with Topeka Drive Elementary School. Children will have access to 12 sinks, 8 toilets and 8 urinals. Bathrooms are shared bathrooms with Topeka Drive Elementary School.

Room 33 will be used for YMCA school age child care. The multi-purpose room will be used as an isolation area, facility also has an isolation kit to be used in the classroom when the multi-purpose room is unavailable.

Indoor Activity Space measurements: Under Title 22 Regulation 101538.3(c) Indoor Activity Space for School-Age Children and Health and Safety Code Section 1596.806(a)(1) a measurement of the facility is not required.

Regulation 101538.3(c) School-age childcare programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for indoor activity space:

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY TOPEKA
FACILITY NUMBER: 197495037
VISIT DATE: 04/05/2022
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
26
27
28
29
30
31
32
Health and Safety Code Sections 1596.806(a)(1) : (a) A room used as a classroom by a school-age child care program shall not be required to meet the square footage or toilet requirements for child day care centers if the program is operated on (1) A functioning school site in the same facilities that have housed school children during the day, before or after school hours, or before and after school hours.

Outdoor Play measurements: Under Title 22 Regulation 101538.2(c)(1) Outdoor Activity Space for School-Age Children and Health and Safety Code Section 1596.806(b)(1) a measurement of the outdoor activity space is not required.

Regulation 101538.2(c)(1): (c) School-age child care programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for outdoor activity space, (1) Health and Safety Code Sections 1596.806(b), (b)(1) and (d) pertain to the exemption from square-footage requirements for outdoor activity space for school-age child care programs that meet the requirements of Health and Safety Code Section 1596.806.



Health and Safety Code Section 1596.806(b)(1): (b) School grounds, other than rooms used as classrooms, used by a school-age child care program operated on a functioning school site pursuant to either paragraph (1) or (2) of subdivision (a) shall be exempt from all of the following requirements imposed by the department on child day care facilities: (1) Fencing, outdoor activity space, toilet, and isolation space requirements....

Indoor/Children’s Area:

All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard were observed to be free of obstruction. The child care center was observed be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Floors of all rooms have a surface that is safe and clean. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to be meet the needs of the children. All play equipment and materials used by children were observed to be age-appropriate. LPAs observed that each child has an individual permanent or portable storage space for his/her clothing, personal belongings. All materials and surfaces accessible to children, including toys, were observed to be free of toxic substances.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY TOPEKA
FACILITY NUMBER: 197495037
VISIT DATE: 04/05/2022
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
26
27
28
29
30
31
32
Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs observed the use of Brita Water Filter system and a water fountain in the classroom and outdoors. The licensee shall take measures to keep the center free of flies, other insects, and rodents, Topeka Drive Elementary School handles the pest control. All containers used for storage of solid wastes, including moveable bins, were observed to have a tightfitting cover that is kept on; were observed be in good repair; and were observed be leakproof and rodent-proof.

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were observed to be inaccessible to children. LPAs advised storage areas for poisons shall be locked. Poisons were not observed during visit. The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children: LPAs observed a current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

A center shall be equipped to isolate and care for any child who becomes ill during the day. The isolation area is located in the multi-purpose room to afford easy supervision of children by center staff. Facility has isolation kit available in the classroom with a cot to be used when the multi-purpose room is not available. The isolation area shall be equipped with a mat for each ill child. The isolation area shall not be located in the kitchen area or the general-use toilet area.

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility. Director tested the carbon monoxide detector LPAs were able to hear a successful test. Facility has a working phone as a designated program cell phone.

In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: The licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted. Facility completes a wellness check on all children entering the school age program from the elementary program.

Smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b).

Restrooms:

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY TOPEKA
FACILITY NUMBER: 197495037
VISIT DATE: 04/05/2022
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
26
27
28
29
30
31
32
All toilets, handwashing and bathing facilities observed to be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

Toilets used by school-age children were observed to provide individual privacy. Toilet facilities shall not be used simultaneously by children of both sexes.

Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).Notwithstanding (e) and (e)(1) above, handwashing fixtures shall not be required to deliver hot water.

There shall be one toilet and one handwashing fixture, separate from and in addition to the number of toilets and handwashing fixtures required in (h) above, designated for use by children who are ill, for use by staff, and for emergency use. Restroom for children in isolation area is located near the multi-purpose isolation room. LPAs observed restroom to be a single use restroom with one toilet and one sink.

Common towels or washcloths are prohibited.

Outdoor:

Shaded rest area for the children was observed with tables under the shade structure in addition to shaded grass area under trees. LPAs observed the outdoor area to be free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. Elementary school has monkey bar climbing equipment that YMCA Director stated are off limits to YMCA children.

The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence was observed to be at least four feet high.

LPAs advised any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. This shall include, but not be limited to, incinerators, air- conditioning equipment, water heaters, and fuse boxes.

No pools or bodies of water were observed at facility.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY TOPEKA
FACILITY NUMBER: 197495037
VISIT DATE: 04/05/2022
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
26
27
28
29
30
31
32
Health Related Services:

Medications shall be kept in a safe place inaccessible to children. LPAs observed a locked box for the storage of medications. Facility has access to a refrigerator to store any medication that requires refrigeration.

The licensee has developed and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given. LPAs observed facility plan for IMS, parent authorization, and medication logs.

Food Service:

YMCA will provide all snack foods for students in the YMCA program. On occasion when full day care is offered parents will provide children lunch and YMCA will provide two snacks.

Postings:

LPAs observed all required postings. Postings observed: copy of the LIC 613A (9/96), PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster.

Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

LPAs observed posted signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5 FORM: LIC 610

LPAs observed a disaster and mass casualty plan of action. Contingency plans for action during fires, floods and earthquakes including, but not limited to, the following: FORM: LIC 9148

The following was discussed:

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,

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: YMCA OF METRO LA/NORTH VALLEY TOPEKA
FACILITY NUMBER: 197495037
VISIT DATE: 04/05/2022
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
26
27
28
29
30
31
32
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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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)/ (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 platform.

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.

The following corrections are needed before a licensure will be considered. Corrections are due by 4/22/2022:

· LIC 200A Application to be completed for an update in hours of operation, this document due 4/08/2022.

· Revised application financial documents LIC 401 and LIC 403.

· Once LIC 200A is received an amended fire clearance will be submitted to the Fire Department.

· New approved fire clearance from fire inspector will be required.

An exit interview was conducted with the above items discussed and a copy of this report was provided to the Vice President, Youth Development, Christopher Jefferson, Claudia Carmona, Senior Program Director, and Jacqueline Quintero, Director. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6