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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405695
Report Date: 07/19/2019
Date Signed: 07/19/2019 11:45:53 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 - RICHMOND CDCFACILITY NUMBER:
073405695
ADMINISTRATOR:DILLON, SHANNONFACILITY TYPE:
830
ADDRESS:485 LUCAS AVENUETELEPHONE:
(510) 412-5640
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:32CENSUS: 0DATE:
07/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Pamm Shaw, Kim Bonnema, and Shannon DillonTIME COMPLETED:
12:00 PM
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A Prelicensing Visit for a TEMPORARY RELOCATION was conducted today 7/19/19 by Licensing Program Analyst (LPA) Mayla Mendoza. LPA met with center director, Shannon Dillon, Vice President Pamm Shaw, and Area Manager Kim Bonnema. The infant center will temporarily relocate from 485 Lucas Ave. to 263 So. 20th St. in 1 classroom. A temporary license number will be issued. A health and safety inspection was conducted inside and outside.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA 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.

The center has obtained an approved fire safety inspection from the City of Richmond Fire Department on 6/4/19.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A license for 32 infants will be issued pending:

*room setup
*sinks

An exit interview was conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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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