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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212377
Report Date: 06/20/2019
Date Signed: 06/20/2019 12:15:16 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 STEWARTFACILITY NUMBER:
070212377
ADMINISTRATOR:COVEY, PAULAFACILITY TYPE:
840
ADDRESS:2040 HOKE DRIVETELEPHONE:
(510) 262-6588
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:62CENSUS: 23DATE:
06/20/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tyler BirssTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Annual Required inspection. There were 3 staff and 23 children present when LPA arrived. LPA met with Acting Director Tyler Birss. Mr. Birss is the acting director during the summer. During the school year he is the director at YMCA of the East Bay Y-Kids Olinda site.

Furniture and equipment was observed to be in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit. The toilets and sinks were in operable condition. The floors were free of tripping hazards. The kitchen/food preparation and storage areas were observed to be clean and free of evidence of rodents. Food is protected against contamination. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment was observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls.

The facility is operating within its licensed capacity. The facility is within ratio today with one teacher supervising no more than 14 children. LPA did not observe any child left without visual supervision or unattended during the inspection. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities as stated by Mr. Birss . LPA verified both opening and closing staff have current CPR/First aid training. A physical census was taken of all children present and crossed referenced with the sign in and out sheets.

The director understands that prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall obtain a clearance or criminal record exemption.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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 STEWART
FACILITY NUMBER: 070212377
VISIT DATE: 06/20/2019
NARRATIVE
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A sample of children’s records were reviewed. Files reviewed contained emergency information. Staff records reviewed have required health screening and immunization.

This facility provides Incidental Medical Services-IMS. LPA reviewed the storage of medication and equipment and supplies, and reviewed children’s, personnel, and administrative records. LPA discussed the need to update the centers plan of operation to reflect IMS plan. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173. The following information regarding ADA was provided to licensee…US DOJ toll free ADA Information Line (800) 514-0301 and the link to FAQ about child care and ADA http://www.ada.gov/childqanda.htm

Director was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

The facility is in the process of hiring a director for this site. A complete director's package for the new director shall be submitted to CCL by 8/1/19.

See 809-D for deficiencies cited during today's inspection.

Exit interview conducted with Tyler Birss.

Director was provided a copy of the appeal rights.

Notice of Site visit was provided at the time of inspection, and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 3 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 STEWART
FACILITY NUMBER: 070212377
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2019
Section Cited
CCR
101226(e)(1)(B)
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Health-Related Services All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified: Each container shall have an unaltered label.
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The director shall ensure all medication is stored with original labeled container. The director shall develop a written plan to ensure medication is stored properly and submit a copy of the plan to CCL by 7/22/19
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This requirement was not met as evidenced by: LPA observed epi- pen and inhaled medication stored that was not in the original labeled container, which poses a potential risk to the health and safety of children in care
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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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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