070212375-10-2-2019-02-CC-PPEN-BGKUXZ-20191002155910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070212375
Report Date: 10/02/2019
Date Signed: 10/02/2019 03:59:23 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 OLINDA		FACILITY NUMBER:	070212375
ADMINISTRATOR:	ZETTA SEALS		FACILITY TYPE:	840
ADDRESS:	5855 OLINDA ROAD		TELEPHONE:	(510) 262-6558
CITY:	EL SOBRANTE	STATE: CA	ZIP CODE:	94803
CAPACITY:	40	CENSUS: 31	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Tyler Birss		TIME COMPLETED:	03:55 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 1320. LPA met with facility director, Tyler Birss, and toured all areas utilized for childcare for a health and safety inspection. Also present at the time of LPA's arrival were eight school age children in care and three additional teaching staff. After LPA's arrival additional children in care arrived bringing the on site census total to 31 school age children with one additional teaching staff arriving also. Two of the teaching staff are qualified teachers, one is a teacher, and one of the teaching staff is an aide. The facility is within ratio and capacity and children are being supervised at all times including transitions and activities. Director of School Age Programs, Audacious Wilson, also arrived and met with LPA during this inspection. This school age care program operates out of one classroom, the portable classroom, on the grounds of Olinda School. The facility was most recently inspected by the fire department within the past year. The facility has multiple smoke detectors, a working carbon monoxide detector, fully charged fire extinguisher and pull fire alarm. Hazardous items/cleaning supplies are stored inaccessible to children in care. Per facility director, there are no firearms present or stored on the premises. Furnishings 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. The facility serves snacks and there is a snack menu posted. There are working water fountains indoors and outdoors for children's drinking waters as well as a pitcher of water indoors. Continued on Page 2***************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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 Y-KIDS OLINDA	FACILITY NUMBER: 070212375
	VISIT DATE: 10/02/2019

NARRATIVE

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For outdoor play, the program uses the playgrounds of Olinda School. There is shade available and climbing structures/equipment are age appropriate and securely anchored with cushioning under and around the equipment. Play equipment is maintained by the school district. There are no observed hazardous conditions and no accessible bodies of water are present.

LPA reviewed the facility, personnel and children's records including children's emergency ID forms, parents' rights forms, staff teaching qualifications and staff background clearances. All required postings are present including one exception. Multiple staff present have current CPR/First Aid certification. Teacher qualification form was completed for one teacher during this inspection.

Tyler Birss is acting interim director with an exception on file.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. At 1420, LPA observed that children, C1 and C2, had prescription medications present without signed parental consents available. 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. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The attached Type B deficiency was cited during this inspection. A notice of site visit was provided and is to remain posted for 30 days. A copy of the appeal rights and a copy of this report were provided and this report is to remain in the facility records for a period of three years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 OLINDA	FACILITY NUMBER: 070212375
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/17/2019 Section Cited	1 2 3 4 5 6 7	101226(e)(3)(B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child. This facility was not in compliance with this requirement at evidenced by LPA's observation that two children,
	8 9 10 11 12 13 14	C1 and C2, had prescription medications present at this facility without a signed parental consent available for the medications posing a potential risk to the health and safety of the children.	8 9 10 11 12 13 14	and $100 per day until corrected.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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