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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213033
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:59:29 PM


Document Has Been Signed on 12/20/2023 02:59 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS WARM SPRINGSFACILITY NUMBER:
010213033
ADMINISTRATOR:DE JESUS DIAZ, MARIAFACILITY TYPE:
840
ADDRESS:47370 WARM SPRINGS BLVD.TELEPHONE:
(510) 683-9165
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:49CENSUS: 22DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Ivonne Viscarra- DirectorTIME COMPLETED:
03:15 PM
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On 12/20/2023, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Case Management - Other inspection. A visit was conducted due to facility requesting to go from Inactive License Status to Active License status. LPA met with Director Ivonne Viscarra. Also present during today's visit was 1 additional staff member and 22 school aged children. LPA conducted a health & safety inspection of the facility.

Facility uses a portable classroom located on the campus of Warm Springs Elementary School. Facility staff stated that facility utilizes the elementary school bathrooms and playground. Staff understand that children are not allowed to commingle with the elementary children who are not enrolled in the program during childcare hours.

This Facility is now on active status as of today 12/20/23. No deficiency was cited 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 Director Ivonne Viscarra.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023
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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