013411362-12-20-2021-02-CC-CCON-C9VRTF-20211220121816

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013411362
Report Date: 12/17/2021
Date Signed: 12/20/2021 12:18:21 PM

COMPREHENSIVE INSPECTION

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:	KIMBERLY YAMATO		FACILITY TYPE:	840
ADDRESS:	1216 SOLANO AVENUE		TELEPHONE:	(510) 524-9737
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	66	CENSUS: 18	DATE:	12/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Jessica Rauf		TIME COMPLETED:	05:09 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 Jessica Rauf, Center Director, for an unannounced required random annual. 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 6:00 PM, Monday through Friday. There are 18 school age children and 5 staff members including the center director. Two children's files and 2 staff files were reviewed by the LPA and the licensee on 12/17/21 at 3:39 PM. Children and Staff records are complete. Sign In and Sign Out Sheets were reviewed. Classrooms: The entire center was inspected. There are adequate play and learning materials available. Furniture and equipment are 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 disposable cups for water. The isolation area for sick children is a classroom. The isolation bathroom is a separate stall in the girl's bathroom. Bathrooms: 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. 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 a morning and afternoon snack. Children bring their own lunches. Inspection of Outdoor Play Area: There are age appropriate toys and materials for the children. There 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. This is an electronic copy of a hand written report.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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: 12/17/2021

NARRATIVE

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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 emergency bathroom. Records: Required forms were posted. Facility is moving to another facility which is located at 1000 Jackson Street. This facility will be temporarily closed.

The facility provides Incidental Medical Services - IMS. LPA reviewed the storage of medication and equipment, supplies, reviewed children's, personnel and administrative records. LPA discussed the need to update the center's plan of operation to reflect IMS plan.

There were no deficiencies cited during this inspection. A site notice was posted. An exit interview was conducted. Appeal Rights were discussed. This report must remain available for public review for 3 years.

This is an electronic copy of a hand written report. Signatures for this report are on file.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC809 (FAS) - (06/04)

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