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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013419475
Report Date: 05/01/2020
Date Signed: 05/04/2020 10:24:33 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2020 and conducted by Evaluator Arminder Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20200303084501
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: DATE:
05/01/2020
ANNOUNCEDTIME BEGAN:
12:15 AM
MET WITH:Yolanda GarnettTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is out of ratio
INVESTIGATION FINDINGS:
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On 05/01/2020 at 1:30PM Licensing Program Analyst (LPA) Arminder Singh, conducted a Zoom Meeting with Director, Yolanda Garnett to deliver the findings regarding the above allegation. During the investigation LPA interviewed both Director and Teachers. Based on interviews conducted it is determined that the facility has operated out of ratio on multiple occasions with teachers having to shuffle kids around to meet ratio regulations. Based on interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is to be substantiated.

PLEASE SEE TYPE A DEFICIENCY on 9099-D Page
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 02-CC-20200303084501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/01/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/08/2020
Section Cited
CCR
101216.3(a)
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101216.3 Teacher-Child Ratio:(a) (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance[...]
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By POC Date 05/08/2020 Director will send LPA Singh a written statement explaining the undertstanding of the regulation and plan on how the facility will ensure they are in ratio moving forward.
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Per LPA's investiation and interview of Director and Teachers facility has been out of ratio on mulitple occasions. This poses an immediate risk to the health and safety of children.
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Due the issuance of a Type A Citation during today's visit, a copy of this Licensing Report must be POSTED AND PROVIDED to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.
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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2