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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215822
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:34:44 PM


Document Has Been Signed on 10/26/2022 12:34 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 FOREST PARKFACILITY NUMBER:
010215822
ADMINISTRATOR:KINCHELOE, JENNIFERFACILITY TYPE:
840
ADDRESS:34402 MAYBIRD CIRCLETELEPHONE:
(510) 793-2630
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:62CENSUS: 5DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Chaitali BandypadhyayTIME COMPLETED:
01:00 PM
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On 10/26/2022 at 8:45AM, Licensing Program Analyst (LPA) Kelly Phan met with site director Chaitali Bandyopadhyay for an unannounced Required 1-Year Inspection. Present for this inspection are five fingerprinted and associated staff members and five school-aged children in care. Facility operating hours are 7AM-6PM Monday to Friday. The facility was toured to conduct a health and safety inspection.

At 9:00AM, LPA toured the facility classroom. The facility operates in a portable on the site of Forest Park Elementary School. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classroom. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. The facility provides a PM snack and stored food in refrigerator have original containers and are not expired. On the left side of the room, the facility uses the area for food preparation, which is OFF limits to children. Uncontaminated drinking water is available to children inside and outside the facility as children bring their own water bottles. Per director, the facility has a outside contractor, Cintas who inspects their two 3A40BC fire extinguishers and smoke detectors once every year, last time inspected was September 28, 2022. The facility also has working carbon monoxide and telephone on the premises. There is also an emergency disaster backpack that has a fully stocked first aid inside. LPA also reviewed one child's medication that is in original unaltered container and is not expired with required documentations. LPA also verified that facility has an incidental medical service (IMS) plan on file. Per director, left side of the room is being used as an isolation area for any sick children.

At 9:20AM, LPA toured the facility bathroom. LPA observed adequate amounts of paper towels and hand soap available to children in the two separate bathrooms during today's inspection. No cleaning supplies were observed to be accessible to children. Each bathroom has a stall to provide privacy to each child. There is also a separate bathroom for staff that children does not use. SEE LIC 809 C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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 FOREST PARK
FACILITY NUMBER: 010215822
VISIT DATE: 10/26/2022
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At 9:30AM, LPA and site director toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls, although there were several patches on the cushioning materials that were ripping apart. Per director, the play structure is shared with the school and other children as it is a neighboring park. LPA reminded director to always check for any potential hazardous items around the play structure as it is shared with the public. Director states that she does a visual check before children comes out to play. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.

At 10:00AM, LPA reviewed six children files and found it to be complete; five staff files were also reviewed and found that one staff member does not have mandated reporter training completed; per director she would have the individual to complete it as she was just hired. At least one individual has a valid CPR and first aid certificate valid on 10/21/2022 to 10/21/2024 at the facility. LPA reviewed sign in/out binder and found that there are two signatures for two children present. Facility roster was reviewed and a copy was obtained. All required documents are posted for public review including a menu that is changed every month. Fire drill log is also conducted once every 6 months, last drill conducted on 09/22/2022. Site director was reminded to associate all individuals to school aged license as she is only associated to preschool license (013422018); Director understood and states that she would use Guardian to transfer everyone. LPA reminded director of the maximum citation of $500.00 if an individual does not have background clearance and/or is not associated to the facility. LPA also confirmed with director that lead testing was completed on 07/28/2022 and a report was obtained today

There were no deficiencies cited. Appeal rights and a notice of site visit notice was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with site director, Chaitali Bandayopadhyay.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 FOREST PARK
FACILITY NUMBER: 010215822
VISIT DATE: 10/26/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. The facility is following and have developed IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing 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.”



Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.


SEE LIC 809 C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS FOREST PARK
FACILITY NUMBER: 010215822
VISIT DATE: 10/26/2022
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Licensee was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to 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, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded 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.

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.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4