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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212375
Report Date: 10/24/2019
Date Signed: 10/24/2019 01:38:50 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 OLINDAFACILITY NUMBER:
070212375
ADMINISTRATOR:ZETTA SEALSFACILITY TYPE:
840
ADDRESS:5855 OLINDA ROADTELEPHONE:
(510) 262-6558
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:40CENSUS: 0DATE:
10/24/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tyler BirssTIME COMPLETED:
01:40 PM
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LPA Dayna Collier met with Center Director Tyler Birss for a case management inspection as a result of receiving an unusual incident report. Present for the inspection were 3 staff members; children have not arrived from school.

As a result of this inspection, there are no deficiencies cited.

A SITE VISIT NOTICE WAS POSTED BY DIRECTOR.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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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