073407414-5-6-2022-52-CC-MPRE-CE6UCK-20220506152806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407414
Report Date: 05/06/2022
Date Signed: 05/06/2022 03:28:18 PM

Document Has Been Signed on 05/06/2022 03:28 PM - It Cannot Be Edited

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	YMCA CHILDCARE - GOLDEN VIEW		FACILITY NUMBER:	073407414
ADMINISTRATOR:	WILLIAMS, JENNIFER		FACILITY TYPE:	840
ADDRESS:	5025 CANYON CREST DR		TELEPHONE:	(925) 735-3981
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	115	CENSUS: 9	DATE:	05/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Jennifer Williams		TIME COMPLETED:	03:20 PM

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On 5/6/2022 at 11:55am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jennifer Williams for an Unannounced Annual Inspection. There were nine (9) school age children and three (3) teachers present during the inspection. During the inspection twenty-two (22) more school age children and three (3) teachers arrived. This is a before and after school facility that operates on the Golden View Elementary School campus in one (1) room. The facility operates from 6:30am – 6:30pm Monday – Friday.

The facility has ample age appropriate materials in the classrooms that were observed to be clean, in good condition and age appropriate for the children present. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. There are two (2) children’s bathrooms with a sink and toilet and one (1) staff bathroom in the facility that are clean and in proper working order. All children have access to clean drinking water. There is a working carbon monoxide detector and smoke detectors, and a fully charged fire extinguisher. The play yard is shared with the Golden View Elementary School. The play structure is sturdy, anchored into the ground and has sufficient cushioning underneath with shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility.

The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible by the entrance. All food is labeled and properly stored. The fire/disaster drill log was complete with the last drill logged 4/29/2022. All medications are properly stored and documented. A physical census of the children and staff were taken and cross referenced with the sign-in and out log. All children were accounted for and properly signed in and all staff have obtained a criminal record clearance. LPA obtained the facilities files, children’s files and staff files. All children files were complete. T1 was missing Tdap immunization and T2 was missing a MMr immunization and T3 was missing an MMr immunization and negative TB test on record (see LIC9102TV).

Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA CHILDCARE - GOLDEN VIEW	FACILITY NUMBER: 073407414
	VISIT DATE: 05/06/2022

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Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting 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 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.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA CHILDCARE - GOLDEN VIEW	FACILITY NUMBER: 073407414
	VISIT DATE: 05/06/2022

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Jennifer Williams.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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