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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700556
Report Date: 01/13/2022
Date Signed: 01/13/2022 03:23:40 PM

Document Has Been Signed on 01/13/2022 03:23 PM - 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 OF THE EAST BAY-SIAC EARLY LEARNING CENTERFACILITY NUMBER:
015700556
ADMINISTRATOR:AMEZCUA, DAISYFACILITY TYPE:
830
ADDRESS:27211 TYRRELL AVENUETELEPHONE:
(510) 640-5836
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
01/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carla Cooper/Monica WilliamsTIME COMPLETED:
03:41 PM
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On 1/13/2022, a Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Director of Field Operations, Carla Cooper and Area Manager, Monica Williams. The applicant has submitted an application for an INFANT license. A health and safety inspection was conducted inside and outside. The infant program will operate in 1 classroom (Classroom 9). Also on site is a Preschool Component operating out of 4 classrooms (Classroom 2, 7, 10, and 11). This facility is on the campus of SIAC Elementary School. Operating Monday through Friday from 7:30AM - 5:00PM. This is a TITLE V Facility. The measurements are as follows:

INDOORS: 811.28 square feet = 23 children
OUTDOORS: 996 square feet = 13 children
Classrooms are equipped with varied age appropriate materials and equipment. There are multiple changing tables within arms reach of a sink. There will be no crib aged children enrolling into the infant component. There are 3 sinks located within the classrooms. Office and staff bathroom will serve as isolation area for ill children. There is a total of 1 play yard for the infant aged children to utilize. The infant yard is barricaded to prevent commingling with preschool aged children. Facility will request an outdoor waiver with sample play schedule due to play yard only measuring for 13 children. Canopies provide sufficient shade in all play yards. The Hayward Unified School District will provide lunch and AM/PM snacks to the children. Facility will have back up snacks on hand. Cabinets with cleaners are locked and/or inaccessible to prevent access to children. Facility will utilize electronic sign in and out. The system allows for a unique identifier and records the date and time of day.
This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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 OF THE EAST BAY-SIAC EARLY LEARNING CENTER
FACILITY NUMBER: 015700556
VISIT DATE: 01/13/2022
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Lovette Trammel a fully-qualified infant/preschool director. Trammel has current pediatric cpr/first aid. There is a working telephone on site. Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 16 infant aged children operating out of 1 classroom (Classroom 9) will be approved once an approved fire inspection clearance is received.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC809 (FAS) - (06/04)
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