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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000569
Report Date: 09/04/2025
Date Signed: 09/04/2025 08:20:29 PM

Document Has Been Signed on 09/04/2025 08:20 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:		MONA ASADFACILITY TYPE:
850
ADDRESS:9630 MAYNE STREETTELEPHONE:
(562) 804-1976
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 103TOTAL ENROLLED CHILDREN: 91CENSUS: 81DATE:
09/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Mona Asad, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Alicia Mooberry met with Director, Mona Asad 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 age 18 months to 30 months. The current hours of operation are: Monday through Friday 7:00am to 5:00pm. The entrance to the facility is locked and parents enter using a call/buzzer system.

All areas identified on the Facility Sketch were inspected. LPA observed the following classroom ratios: Room 1 (2 staff/12 children), Room 2 (2 staff/13 children), Room 3 (2 staff/14 children), Room 4 (2 staff/10 children), Room 5 (2 staff/13 children), Room 6 ( 2 staff/13 Children), Room 7-Toddler Room (2 staff/6 children).


LPA observed teacher-child ratios in compliance and staff fingerprints have the required clearances at this time.

LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. Napping mats are stored appropriately ensuring that bedding is maintained separate for each child. The facility provides sheets and are laundering as needed. LPA observed drinking water with drinking cups readily available in the classrooms. Age appropriate restrooms, sinks and toilets were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. LPA observed cleaners and similar items in inaccessible areas or locked cabinets. The indoor classrooms have surfaces that appear to be clean and safe and there are age appropriate toys and material for children to use. ----- Page 1, Report continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
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
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
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: 09/04/2025
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There are first aid supplies in each classroom and in the play area. Carbon monoxide detectors were found operable in each classroom. Smoke detectors are and fire extinguisher present in the facility. The office is used as an isolation area for ill children, comfortable accommodations are available for children to rest.

The facility operates on the grounds of a church building, however the facility has separate operations. The outdoor play area is enclosed and surrounded by the classroom, exit gates are at least five feet high. Areas around and under climbing equipment have cushion in case of a fall. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free. Toddler play area ia located within the playground and separated by fence.

Meals and snack menus are posted at least one week in advance and are visible to an authorized representative at entrance to the facility and outside classrooms. The facility provides breakfast, lunch, and snack. LPA inspected the kitchen where meals are prepared for availability, quantity, expiration/best by dates and appropriateness for children in care. LPA observed kitchen to be in sanitary condition, cleaning supplies were stored in locked cabinet away from food prep area. LPA reminded director to constantly assess expiration dates on food items that are removed from original packaging and document. LPA observed trash receptacles have tight fitting covers.

LPA observed digital sign in and sign out to ensure children are being properly signed in and signed out by the authorized representative. LPA conducted a Children's Records Review for completeness and to ensure children have proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights etc.on file. The children's roster was available and current.

Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination, Mandated Reporter training, LPA observed 12 out of 12 staff records reviewed to have current Pediatric CPR/1st Aid.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretation and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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.

-----Page 2, Report Continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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: 09/04/2025
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Last Fire/disaster drill conducted on 7/25/25. Role and responsibilities of being a Mandated Reporter were reviewed. Staff has completing Mandated Reporter training.

Licensee 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.

LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors).

LPA verified that the lead testing was completed and in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA observed a water fountain in the play area behind the classrooms, that was covered and inaccessible (photo taken). Per Director the play area is not used regularly by children but might be used when new playground construction is started (date to be determined). LPA discussed Lead testing on all


accessible drinking water fountains or sources of water used for consumption.

There were no violations of Title 22 requirements at this time.

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/tion-process.

Notice of Site Visit provided and must be posted for 30 days.

Exit interview was conducted with Director Mona Asad. Appeal Rights (LIC 9058) was discussed and provided - Page 3 - End of Report

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4