013411362-3-5-2020-02-CC-CCON-BMF2GZ-20200305162357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013411362
Report Date: 03/05/2020
Date Signed: 03/05/2020 04:24:07 PM

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:	KIDS CLUB YMCA		FACILITY NUMBER:	013411362
ADMINISTRATOR:	FIERRO, MAITE		FACILITY TYPE:	840
ADDRESS:	1216 SOLANO AVENUE		TELEPHONE:	(510) 524-9737
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	66	CENSUS: 39	DATE:	03/05/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Kimberly Yamato		TIME COMPLETED:	04:40 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	Licensing Program Analyst (LPA) Caroline Colson met with Nicole Natividad, Program Director, for an unannounced random annual required inspection at 1:18 PM. The facility is a school age program and operates in 2 classrooms with a kitchenette, 2 bathrooms, a fenced playground. The facility also uses Cornell Elementary's playground after school ends. The staff bathroom is located at Cornell Elementary School. The Hours of Operation are from 7:30 AM to 6:30 PM, Monday through Friday. There are 39 school age children and 6 staff members including the program director. Two children's files and 2 staff records were reviewed by the LPA and the licensee on 03/05/20 at 2:24 PM. C1 and C2 have complete records. Staff records were reviewed. A physical census was taken of all children present and crossed referenced with the sign in and out sheets. CLASSROOMS: The entire center was inspected. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. There is a working telephone on site. There is proper individual storage space for each child. Children are using the indoor and outdoor water fountains. There are separate bathrooms for staff and children. The isolation area for sick children is a classroom. The isolation bathroom is a separate stall in the girl's bathroom. BATHROOMS AND TOILETING AREAS: Toilets and faucets work properly. The children are able to reach the sink and toilets. Toilet paper, soap, and paper towels are all available to the children. Adequate lighting is provided in both bathrooms. Bathrooms have cold and warm water available to the children. INSPECTION OF FOOD SERVICE AREA: Food was inspected for quality and quantity. Menu was posted and available for review. Facility provides only an afternoon snack. Children bring their morning snacks and lunches. Please See LIC 809 C for additional information

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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: KIDS CLUB YMCA	FACILITY NUMBER: 013411362
	VISIT DATE: 03/05/2020

NARRATIVE

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INSPECTION OF OUTDOOR PLAY AREA: There are age appropriate toys and materials for the children. They is a large play structure and many other play equipment available for use. All climbing equipment is properly anchored to the ground with adequate and appropriate cushioning under them. The play ground is free of miscellaneous debris or hazards such as tree branches, cans, bottles and broken glass. HEALTH RELATED SERVICES: Director states that there are medications stored in the director's office. Earthquake emergency items are available in the cottage and in bins located behind the front desk. The first aid kit is complete. Pediatric CPR and First Aid certificates are current and expire on February 2, 2022. RECORDS: Required forms were posted in an public accessible area.

This facility provides Individual Medical Services - IMS. LPA reviewed the storage of medication and equipment and supplies, and reviewed children’s, personnel, and administrative records. LPA discussed the need to update the centers plan of operation to reflect IMS plan. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173.

LPA discussed the director's requirements to ensure all staff have the appropriate documentation.

The childcareadvocatesprogram@dss.ca.gov is the email address for the licensee to sign up to receive PINS.

Licensee was asked to go to our website at www.ccld.ca.gov to ensure that she is informed of all new laws and regulations.

A site notice was posted. An exit interview was conducted. Appeal rights were discussed and given. This report must remain available for public review for 3 years.

There were no deficiencies cited during this inspection.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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