013422018-8-29-2023-52-CC-MPRE-CV6Q2M-20230829114722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422018
Report Date: 08/29/2023
Date Signed: 08/29/2023 11:47:31 AM

Document Has Been Signed on 08/29/2023 11:47 AM - 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 Y-KIDS CARE FOREST PARK		FACILITY NUMBER:	013422018
ADMINISTRATOR:	KINCHELOE, JENNIFER		FACILITY TYPE:	850
ADDRESS:	34402 MAYBIRD CIR.		TELEPHONE:	(510) 793-2630
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	24	CENSUS: 0	DATE:	08/29/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Chaitali Bandyopadhyay		TIME COMPLETED:	11:45 AM

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	On 8/29/2023 at 9:40am Licensing Program Analyst’s (LPA’s) Morgan Pringle and Jaleesa Jackson met with Director Chaitali Bandyopadhaya for an Unannounced Case Management Visit. The facility is requesting to reactivate their license. The facility has been on inactive status since 11/7/2022 and will reopen 9/11/2023. There were no children present during the inspection. The facility operates on the far-right side of the Forest Park Elementary School campus. One (1) classroom was toured for a health and safety inspection. The facility uses the one (1) room for their school age program as well. The facility operates from 8:30am – 11:30am, Monday – Friday. The facility has ample age-appropriate materials in the classroom that were observed to be clean and in good condition. All toxins, cleaning products, children’s medication, and hazardous materials were observed to be in inaccessible areas. The children’s bathrooms are in good condition with ample number of sinks and toilets. There is a separate staff bathroom on site as well. There is one (1) fully charged fire extinguisher, one (1) carbon monoxide detector, and smoke detectors on site. Facility does not transport children. The food prep area is clean, well maintained, and free from defects. All food on site is properly labeled and stored. Facility only provides snacks for the children. All food that will be brought from the children’s home will be properly labeled and stored. All children have access to clean drinking water as well. The outside play yard is clean with ample age-appropriate materials for the children. The facility uses the far-left play structure on the elementary school grounds. The play yard is also open to the public park. There is plenty of shade and the play structure has ample cushion for extra safety. LPA’s did not observe any harmful or unattended bodies of water in or around the facility.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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 Y-KIDS CARE FOREST PARK	FACILITY NUMBER: 013422018
	VISIT DATE: 08/29/2023

NARRATIVE

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All required postings, including the menu and a waiver for a centralized criminal record clearance, are posted by the entrance of the facility. The facility uses a paper sign in/out sheet for the children’s parents and authorized representatives.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Personnel and facility roster must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Licensee was reminded that California law requires facilities to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone, fax, or email. Within seven (7) days from the incident, facilities must submit the Unusual Incident/Injury form (LIC 624) to the Department. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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 Y-KIDS CARE FOREST PARK	FACILITY NUMBER: 013422018
	VISIT DATE: 08/29/2023

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Chaitali Bandyopadhaya.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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