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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406657
Report Date: 09/13/2019
Date Signed: 09/13/2019 02:27:03 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 CHILDCARE- HIDDEN VALLEYFACILITY NUMBER:
073406657
ADMINISTRATOR:ODELL, MANDIFACILITY TYPE:
840
ADDRESS:500 GLACIER DRTELEPHONE:
(925) 372-7271
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:60CENSUS: 15DATE:
09/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mandi OdellTIME COMPLETED:
02:45 PM
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A Case Management inspection was conducted today, September 13, 2019 by Licensing Program Manager (LPM) Wynn Norona. LPM met with director, Mandi Odell. The center has applied for an increase of capacity from 60 to 70 school-age children. The center has requested to use the main area of Room A-pod and remove Room A6. Currently the center is using Room A5 and Room A6. The program is inside Hidden Valley Elementary School which exempts the program from fencing, outdoor activity space, toilet, and isolation space requirement. There are 15 school-age children with 5 staff present during the inspection. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: EXEMPT
OUTDOORS: EXEMPT

The center has obtained an approved fire clearance from Contra Costa County Fire Department on 8/20/19. The center was found to be clean, safe, sanitary and in good repair. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. LPM provided a copy of the appeal rights and the signature on this form acknowledges receipt of these right. An exit interview was conducted with director, Mandi Odell.

A license for 70 school-age children using the main Room A-pod and Room#A5 is recommended pending the submission of Superintendents Certification that the rooms listed above can accommodate the number of children requested.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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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