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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000569
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:51:26 PM

Document Has Been Signed on 05/10/2024 03:51 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:YMCA GLB MAYNE ST STATE PRESCHOOLFACILITY NUMBER:
198000569
ADMINISTRATOR/
DIRECTOR:		BERTINA XAVIERFACILITY TYPE:
850
ADDRESS:9630 MAYNE STREETTELEPHONE:
(562) 804-1976
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 103TOTAL ENROLLED CHILDREN: 103CENSUS: 86DATE:
05/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Mona Asad / DirectorTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analyst's ( LPA's) Ashley Calderon and Susann Sanchez met with Director Mona Asad who assisted analysts with a tour of the facility. This is a Preschool Program and Toddler component both separated. The program serves 96 preschool children ages two (2) until entry into kindergarten; and seven (7) toddlers ages 18 months to 30 months. The current hours of operation are: Monday through Friday 7:00am to 5:00pm.

LPA's conducted a guided tour with director of the physical plant. Areas identified on the Facility Sketch were inspected. LPA's observed the following: Room 1- Room 7 (Classrooms), outdoor areas, furniture and equipment were inspected for good repair. Each classroom have their own cleaning supplies and is kept inaccessible to children. Director stated during this time no poisons are kept at the facility, LPA advised Director if poisons were to be stored at the facility to lock poisons to remain inaccessible to children in care. Director stated a pest control company conducts a pest inspection during school closing hours to ensure facility remains pest free. Director stated no weapons or firearms are kept on premises.

LPA's observed telephone service, central heating and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. During time of visit children were resting / napping. LPA's observed children having their own water bottle, water jugs in play yards and fountain water in the play yard area. LPA's reviewed water lead and facility was clear for water measurements. Age appropriate sinks and toilets were inspected for availability, good repair, safety and sanitation.

Outdoor play yard has two play structures, separated per age group facility program serves (Preschool/ Toddler). Areas around and/or under climbing equipment have cushioning material to absorb injuries. All materials and surfaces accessible to children appear to be safe. Play equipment and toys are age appropriate per program.


(Page 1, Continuation on LIC809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB MAYNE ST STATE PRESCHOOL
FACILITY NUMBER: 198000569
VISIT DATE: 05/10/2024
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Kitchen was observed to have food menu post, each classroom has a posted menu, menus are posted one week in advance where it is visible by the child's authorized representative view. Food was observed by LPAs, facility serves breakfast, lunch, dinner and snacks were reviewed for quantity and expiration dates. Facility uses commercial food distribution company named Shamrock Food, Per kitchen staff food is delivered every two weeks.

The facility has one or more functioning smoke detectors and carbon monoxide detectors, LPA tested detectors and was found operable. Per Licensee, Disaster and Fire drill is conducted monthly, last fire drill conducted on 4/12/24. LPAs observed First Aid supplies in each classroom and a main first aid against the wall near play yard. Fire extinguishers are type 2A-10BC, extinguishers were observed to serviced and fully charged. Directors CPR/ First Aid expires on 1/2025, Teacher #1 Mandated Reporter Expires on 9/1/25. LPAs reviewed a total of three children files all documentation were found on file. LPA's reviewed a total of two staff files. LPA reviewed administration qualifications documentation's to update Administrator/ Director name for facility. Per Director the facility uses electronic sign in and out system, on an application called Care Connect to ensure children are being properly signed in and signed out by the authorized representative. LPA's observed Toddler Room for the 15 minute Safe Sleep Log. The children's roster was available and current. Rooms 2,4 and 5 had children who have medication on premises. Medication is kept in children's designated classroom and kept inaccessible to children. LPA's consulted with Director regarding Child #1 medication label and to ensure they have a plan to check expiration dates. Files of children who have medications were reviewed and facility has medication plan for each child and appropriate documentation's.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

(Page 2, continuation LIC809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB MAYNE ST STATE PRESCHOOL
FACILITY NUMBER: 198000569
VISIT DATE: 05/10/2024
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Facility representative was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
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-care-centers/

(Page 3, Continuation on LIC 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB MAYNE ST STATE PRESCHOOL
FACILITY NUMBER: 198000569
VISIT DATE: 05/10/2024
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Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the facility representative , confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Per California Code of Regulation, Title 22, no deficiencies were cited on today's visit.

Exit interview conducted and report was reviewed with the Facility Representative / Director Mina Asad.

(End of Report)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
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