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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290795
Report Date: 09/24/2026
Date Signed: 09/24/2026 03:57:49 PM

Document Has Been Signed on 09/24/2026 03:57 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YMCA OF METRO LA/SANTA CLARITA VALLEY MEADOWSFACILITY NUMBER:
191290795
ADMINISTRATOR/
DIRECTOR:		NATALIE GALSTYANFACILITY TYPE:
840
ADDRESS:25577 FEDALA ROADTELEPHONE:
(310) 486-2870
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 82TOTAL ENROLLED CHILDREN: 82CENSUS: 63DATE:
09/24/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:26 PM
MET WITH:Leleynna RodriguezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On September 23, 2026, at 2:26 PM., Licensing Program Analyst (LPA) Calloway, made an unannounced case management inspection to the above facility. The purpose of the case management was to follow up on a self-reported Unusual Incident Report (UIR) submitted to the Palmdale Regional Office. LPA met with Lianna Rivas and toured the facility with the representative, and observed no daycare children and two staff in active care. The representative stated the children were signed in and were just at the book fair and will return shortly. All adults 18 years and over have Criminal Record Clearance and Child Abuse Central Index Clearance and are associated with the facility. At 2:36 PM. the site director, Leleynna Rodriguez and sixty-three-day care children arrived with six staff.

On September 8, 2026, the reported information to the region office stated that on September 8, 2026, during class time the staff gave a child (C1) medication and dosage amount that was meant for a different child, and it was not the medication prescribed to (C1). (C1) supposed to have 2.5 mg of their medication and was given 5 mg of someone else’s medication. The staff notified the parents and Poison Control and the child (C1) was monitored.

During this inspection, LPA conducted interviews with relevant parties involved. At 3:45 PM., LPA reviewed records. Based on interviews and record reviews, it was determined after the medication was given, (C1) was monitored by the staff, the parents picked (C1) up at their normal pick-up time, and (C1) did not require further medical treatment. However, the staff neglected to follow their medical policy procedures for administering medication to a child and it resulted in the staff issuing the wrong medication and dosage to (C1) which could have resulted in further injury.

Francisco Pedroza
Kuliema Calloway
DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2026
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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Document Has Been Signed on 09/24/2026 03:57 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/24/2026 at 02:41 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: YMCA OF METRO LA/SANTA CLARITA VALLEY MEADOWS
FACILITY NUMBER: 191290795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2026
Section Cited
CCR
101226(e)(3)(A)

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101226 Health-Related Services
(e) In centers where the licensee chooses to handle medications:(3) Prescription medications...(A)Prescription medications.. accordance... label directions as prescribed by...child's physician this requirement was not met as evidenced by:
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The entire staff is no longer allowed to administers medication either myself and my assistant we went over a training and it was on a Google document and once I have it approved I can have the staff sign off and send a copy to LIcensing by the POC date.
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Based on interview and record review, staff administered the wrong medication and dosage that was meant for a different child to (C1) during class time which is a potential health, safety, or personal rights risk to the persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Francisco Pedroza
NAME OF LICENSING PROGRAM MANAGER:
Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: YMCA OF METRO LA/SANTA CLARITA VALLEY MEADOWS
FACILITY NUMBER: 191290795
VISIT DATE: 09/24/2026
NARRATIVE
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There is one Type B deficiency cited during this inspection for Health-Related Services CCR. See LIC 809D page attached to this report.

An exit interview was conducted, a copy of this report was read, a Notice of Site Visit, and Appeal Rights were given to Leleynna Rodriguez, at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting may result in a $100 civil penalty.
NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC809 (FAS) - (06/04)
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