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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070213769
Report Date: 10/23/2020
Date Signed: 10/23/2020 03:52:42 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:YWCA OF CONTRA COSTA COUNTY - DELTA YOUTHFACILITY NUMBER:
070213769
ADMINISTRATOR:MANNING, MICHELLEFACILITY TYPE:
850
ADDRESS:605 PACIFICA AVENUETELEPHONE:
(925) 458-8183
CITY:BAY POINTSTATE: CAZIP CODE:
94565
CAPACITY:60CENSUS: 8DATE:
10/23/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tanya DeanTIME COMPLETED:
04:00 PM
NARRATIVE
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On 10/23/2020 Licensing Program Analyst (LPA) Jaylena Miller met with Director Tanya Dean, for the purpose of a Case Management Visit. Present for the inspection was 3 staff members including the director and 8 preschool children. The facility self reported on 10/01/2020 and a copy of the Unusual Incident Report was reviewed by LPA. Per the report, A staff member failed to make sure that all children who were playing outside, returned to the class after the play period was over. As a result, there was an Absence of Supervision, one child was left outside alone on the playground. Although the facility states that the child was left outside alone for less than two minutes, Title 22 Regulations, 101229(a)(1) states that no child(ren) shall be left without the supervision of a teacher at any time including visual supervision.

The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next year, a copy of this report. Parents are to sign an LIC 9224- Acknowledgment of Receipt of Licensing reports and this form shall be placed in each child's file. Failure to post report and or provide a copy of this report to parent's/authorized guardians can result in additional citations.

This report must remain on file for three years. The Director was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.

The facility was advised that due to the serious nature of this incident, a Non Compliance Conference with Community Care Licensing Management may be required to discuss the Unusual Incident.

Notice of site visit was provided and must be posted for 30 days. Exit interview conducted with Director Tanya Dean.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
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: YWCA OF CONTRA COSTA COUNTY - DELTA YOUTH
FACILITY NUMBER: 070213769
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2020
Section Cited

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Responsibility for Providing Care and Supervision 101229(a)(1)
No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).

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This requirement was not met as evidenced by document review of unusual incident report and director interview. This poses an immediate health and safety risk to children in care.
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A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by 10/26/2020 end of day.

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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: Jaylena MillerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2020
LIC809 (FAS) - (06/04)
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