073405655-10-30-2019-02-CC-PPEN-BHFPD4-20191030111256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405655
Report Date: 10/30/2019
Date Signed: 10/30/2019 11:13:01 AM

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 - GIANT ROAD CDC		FACILITY NUMBER:	073405655
ADMINISTRATOR:	WALKER, JODY		FACILITY TYPE:	850
ADDRESS:	919 LAKE STREET		TELEPHONE:	(510) 235-1840
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	36	CENSUS: 20	DATE:	10/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jessica Murillo/Jody Walker		TIME COMPLETED:	11:20 AM

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 9:00. At arrival, LPA met with teacher, Jessica Murillo, and began a tour of the facility. Also present at that time were three additional teaching staff and the facility kitchen staff. All adults present were background cleared. Three of the staff were qualified teachers and one was an aide. The facility was within ratio and capacity. Facility director, Jody Walker, arrived while LPA was still present and accompanied LPA for the remainder of the health and safety inspection of this facility. This facility operates out of two classrooms (1 and 2) at 919 Lake Street. Both classrooms were inspected including counter tops and surfaces, furnishings, equipment and storage areas. The front window in Classroom 2 was being repaired at the time of this inspection without any impact to the classroom area or children. The classrooms have age appropriate furnishings and equipment which are in good repair and free of sharp/broken pieces. There were no hazardous items/toxins observed to be accessible to children in care. Per director, the most recent fire department inspection was in May 2019. There is a centralized smoke detector/fire alarm system, fully charged fire extinguisher and working carbon monoxide detector. There are individual storage cubbies for children's personal belongings. Sleeping cots are present and children's linens for sleeping are stored individually per child and laundered at least weekly on site. The facility serves breakfast, lunch and snacks which are catered from Kidango main kitchen. There is a menu posted. The kitchen/food prep and storage areas appear clean and free of pests. 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: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

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 - GIANT ROAD CDC	FACILITY NUMBER: 073405655
	VISIT DATE: 10/30/2019

NARRATIVE

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The outdoor playground is adjacent to the classrooms and is fully fenced. The outdoor playground is open to the community during non-childcare hours and is used exclusively by this facility during hours of operation. High climbing equipment is securely anchored and free of broken/sharp pieces. There is cushioning around and under the climbing equipment. There are no pools or other bodies of water accessible to children.

LPA reviewed the facility, personnel and children's records including children's admissions agreements, parents' rights forms, and emergency ID forms and staff teaching qualifications and background clearances. All required postings are present. At least one staff member present has current CPR/First AId certification.

Facility 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. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. 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

There were no deficiencies cited during this inspection. A copy of the appeal rights was provided and the notice of site visit was printed and posted and is to remain posted for a period of 30 days. A copy of this report was issued and 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: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

LIC809 (FAS) - (06/04)

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