070212372-7-9-2021-02-CC-PPEN-C4RRWP-20210709132328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070212372
Report Date: 07/09/2021
Date Signed: 07/09/2021 01:23:33 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 Y-KIDS BAYVIEW		FACILITY NUMBER:	070212372
ADMINISTRATOR:	STHEPHENS, SHAELA		FACILITY TYPE:	840
ADDRESS:	3001 - 16TH STREET		TELEPHONE:	(510) 412-5636
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	84	CENSUS: 20	DATE:	07/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Shaela Stephens		TIME COMPLETED:	01:30 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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 11:35 AM. LPA met with facility director, Shaela Stephens, who was present along with three additional teaching staff (one qualified teacher and two aides) and 20 school age children in care. The facility is within ratio and capacity and children are being supervised. All adults present are background cleared. This school age care program operates out of two portable classrooms on the grounds of Bayview Elementary School. Both classrooms were toured for a health and safety inspection. The facility has smoke detectors and working carbon monoxide detectors in each classroom. There are fully charged fire extinguishers present in each classroom. Per facility director, the most recent fire inspection for this facility was within the past month. Per facility director, there are no firearms present or stored on the premises. Classroom furniture and equipment are age appropriate and free of broken/sharp pieces. Surfaces including floors, counter tops and desk tops are free of toxins. Toilets and faucets are age appropriate and in good repair. There are no toxins/hazardous items observed to be accessible to children in care. Required postings are present including one waiver. The facility serves breakfast, lunch and snacks. Kitchen/food prep areas appear clean and free of pests. There is drinking water available indoors via working faucets and individual drinking bottles. Working water fountains are available for outdoor drinking water. The outdoor playground is on the grounds of Bayview Elementary and maintained by the school district. The high climbing/play equipment is currently off limits to children in care for maintenance. There are no pools or other accessible bodies of water are present. Continued on Page 2***********************************************************************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: YMCA OF THE EAST BAY Y-KIDS BAYVIEW	FACILITY NUMBER: 070212372
	VISIT DATE: 07/09/2021

NARRATIVE

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Facility records were reviewed including personnel and children's records. Children's files were complete with required Identification and Emergency Information Forms. Personnel records were complete with immunization records, mandatory reporter training certification, and teacher qualification documents. At least one staff present has current CPR/First Aid certification.

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 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

Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. To subscribe to receive licensing PINs use: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe For Quaterly updates visit the following link: https://www.cdss.ca.gov/inforesources/community-care/self-assessment-guides-and-key-indicator-tools/quarterly-updates.

There were no deficiencies cited during this inspection. An exit interview was conducted and a notice of site visit was printed and is to remain posted for 30 days. A copy of this report was provided and is to be maintained in the facility records for a period of three years.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

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