010210508-5-13-2022-52-CC-MOTI-CEDT2U-20220513142119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010210508
Report Date: 05/13/2022
Date Signed: 05/13/2022 02:21:27 PM

Document Has Been Signed on 05/13/2022 02:21 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	YMCA OF THE EAST BAY Y-KIDS CHADBOURNE		FACILITY NUMBER:	010210508
ADMINISTRATOR:	KWAN, JOSEPH		FACILITY TYPE:	840
ADDRESS:	801 PLYMOUTH AVENUE		TELEPHONE:	(510) 656-7243
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	60	CENSUS: 3	DATE:	05/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Akeena Carino		TIME COMPLETED:	02:40 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 5/13/2022 Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility to conduct an UNANNOUNCED REQUIRED 1 YEAR inspection. LPA met with Director, Akeena Carino and toured the facility for a health and safety inspection. Also present during this inspection were 3 school aged children. The facility is a single-story portable classroom on the campus of the Fremont Unified School Districts Chadbourne Elementary. There is an outdoor playground and large blacktop area. There are separate boys and girls bathrooms available in the building next door adjacent to the playground area. Heating and ventilation is acceptable. All required posted documents were found to be in compliance and prominently posted in public places. There are 2 fully charged fire extinguishers. The room has a working carbon monoxide detector (tested and working), and smoke detectors. The facility has monthly fire and/or earthquake drills, the last one completed was on 5/6/2022. Facility provides AM/PM snacks. The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. There were no hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care. All hazardous materials and toxins are kept out of the reach of children.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CHADBOURNE	FACILITY NUMBER: 010210508
	VISIT DATE: 05/13/2022

NARRATIVE

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The facility uses a sign-in/sign-out log. All children present were properly signed in. The classrooms has trash bins with tight fitting covers to dispose of solid waste. All play equipment is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade was available in the play areas and teachers are always present. 1 staff file and 3 children files were reviewed.

Site 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.

This facility plans to provide Incidental Medical Services. For IMS information see Evaluator Manual – Regulation Interpretations & Procedures for Child Care Centers sections 101173 & 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

No deficiencies are noted on today's date, 5/13/2022. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Akeena Carino.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022

LIC809 (FAS) - (06/04)

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