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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405003
Report Date: 08/08/2019
Date Signed: 08/08/2019 03:05:46 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 - 8TH STREET CDCFACILITY NUMBER:
073405003
ADMINISTRATOR:SPARKS-HUNTER, KARLAFACILITY TYPE:
850
ADDRESS:445 8TH STREETTELEPHONE:
(510) 412-3559
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:82CENSUS: 27DATE:
08/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Karla Sparks-HunterTIME COMPLETED:
03:15 PM
NARRATIVE
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LPA Dayna Collier met with Center Director Karla Sparks-Hunter for a case management inspection as a result of receiving an unusual incident report. Today at 2:15 p.m., there were 3 staff member supervising 27 napping children. The incident occurred when a child was released to the wrong person. A woman arrived to pick up 2 siblings from care in two different classrooms. This person was named on the siblings' forms as someone who was authorized to pick up the children. However, due to a lack of communication between staff and the woman as well as staff's failure to verify the woman's identity, the wrong child was released to the woman. The woman picked up the younger sibling and left the facility with two children which included the wrong child. A staff member observed the group leaving, returned to the classroom and observed the older sibling had not been picked up. The older sibling was still napping in the classroom. Staff were able to reach the woman by her cell phone and the child who was mistakenly released was returned to the facility within 5-8 minutes. The child's parent was informed of the incident.

The attached type A deficiency is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A site visit notice was posted by the Director.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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 - 8TH STREET CDC
FACILITY NUMBER: 073405003
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2019
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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POC: By 8/15/19, a written protocol for staff to follow regarding pick up and/or dismissal of children in care will be sent to Licensing.
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This requirement was not met as evidenced by report review and interviews. This poses an immediate risk to the health and safety of children in care.
A CHILD WAS RELEASED FROM THE FACILITY TO THE WRONG PERSON AND MISSING FOR ABOUT 5-8 MINUTES.
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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: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
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