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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419475
Report Date: 05/17/2019
Date Signed: 05/17/2019 02:25:35 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:YMCA OF THE EAST BAY - 21ST STREET CDCFACILITY NUMBER:
013419475
ADMINISTRATOR:HAYES, KISHAFACILITY TYPE:
850
ADDRESS:756 - 21ST STREETTELEPHONE:
(510) 272-0669
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:103CENSUS: 58DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Alloma GillTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced annual random site inspection for this facility on 05/17/19 at 1010. LPA met with and toured the facility for a health and safety inspection with assistant director, Alloma Gill. Also present at the time of this inspection were 58 preschool age children in care and nine teaching staff, including five qualified teachers, one teacher, and three aids. LPA inspected classrooms 3, 4, 5, and 6 including bathrooms and storage areas. There were no hazardous items or toxins observed to be accessible by children. Each classroom has pitchers and cups for drinking water available for children in care. Furnishings are age appropriate and without observed broken or hazardous conditions. There are age appropriate equipment and play items. At 10:45 AM, LPA observed that there were stacked sleeping cots with sleeping linens on the cots in rooms four and five and that their was no children's identification on the cots. Per assistant director, linens are washed at least weekly at this facility. Facility has multiple functioning carbon monoxide detectors, smoke detectors and fully charged fire extinguishers. Per director the most recent Fire Department inspection was in 2019. There is a fully fenced outdoor play area which is separate to the infant age playground. Climbing equipment is securely anchored with cushioning around and under the equipment. There are no pools or other accessible bodies of water present. This facility serves breakfast, lunch and snacks which are catered by Kidango main kitchen. There are menus posted and available for review. Food storage areas were inspected an appear free of pests. Staff certification in CPR and First Aid is current and valid for more than one staff persons present today. Facility, staff and children's files were reviewed including staff qualifications and background clearances, children's admissions agreements, emergency ID forms and parents' rights forms. Sign in, sign out logs were reviewed. All required posting are present including one waiver. Per assistant director, there are no weapons stored in the child care center. This facility provide Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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 For forms and updates visit www.ccld.ca.gov.

The attached Type B deficiency is cited during this inspection. An exit interview was conducted. Appeal Rights were issued. A Notice of Site Visit was issued and posted. This notice is to be posted for 30 consecutive days. A copy of this report shall be maintained for 3 years and available for public review upon request.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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: YMCA OF THE EAST BAY - 21ST STREET CDC
FACILITY NUMBER: 013419475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2019
Section Cited
CCR
101239.1(c)(2)
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101239.1(c)(2) Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding. This facility was not in compliance with the requirement as evidenced by LPA's observation that there were stacked napping cots in classrooms 4 and 5 which
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This facility agrees to provide a written understanding of the requirement for children's napping linens to be stored separately and indentifiable for each child which will be signed by all preschool staff and submitted to CCL by the POC date. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat
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had sleeping linens on the cots and no children identification present posing a potential risk to the health and safety of children in care.
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violations are $250 per violation and $100 per day until corrected.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
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