010206120-12-21-2022-02-CC-ILOA-CMBVEL-20221221152228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206120
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:22:43 PM

Document Has Been Signed on 12/21/2022 03:22 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	BERKELEY YMCA HEAD START - WEST		FACILITY NUMBER:	010206120
ADMINISTRATOR:	MURRAY, CHERYL		FACILITY TYPE:	850
ADDRESS:	2009 10TH STREET		TELEPHONE:	(510) 848-9092
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY:	70	CENSUS: 12	DATE:	12/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Carlota Hernandez De Cruz		TIME COMPLETED:	03:30 PM

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 December 21, 2022 at 9:30am Licensing Program Analyst (LPAs) Indira Loza met with Site Supervisor Elia Vazquez and Interim Director Carlota Hernandez De Cruz for a Required Annual Inspection. There were 12 preschool age children and six fingerprint cleared staff. The teacher/child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from 7:30am – 5pm Monday through Friday. The preschool operates out of four classrooms. There is also an infant/toddler component on site. All sinks and toilets are observed to be clean and in proper working order. The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. For drinking water indoors and outdoors, children are given small drinking cups. LPA observed a fully charged 2A10BC fire extinguisher. The fire system is hard wired. There is a working combined smoke and carbon monoxide detector in the on the wall across from the kitchen. The outdoor play area is clean with ample age appropriate materials for the children. There is an anchored play structure with cushion underneath. The center has a waiver for the playground to be shared with the toddlers in the infant component. The yard is fully fenced in and has plenty of shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The isolation area will be in the resource room down the hall from the main entrance. The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible. The school provides meals and snacks for the children. The fire/disaster drill log was complete with the last drill logged 12/14/22. A physical census of the children and staff were taken and cross referenced with the electronic sign-in and out log. All children were accounted for and properly signed in. All staff have obtained a criminal record clearance. LPA reviewed all of the current staff records and six children's files. All files were complete and current. ******************************************Report Continues on 809-C*********************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BERKELEY YMCA HEAD START - WEST	FACILITY NUMBER: 010206120
	VISIT DATE: 12/21/2022

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Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to the child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone or fax. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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. The center is providing IMS and has the proper documentation for the child.

Director was reminded that all adults 18 and over, 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.

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/process.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There were no citations issued during today's visit.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Interim Director Carlota Hernandez De Cruz and Area Manager Joshua Jackson.
Report and appeal rights provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

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