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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213000337
Report Date: 11/08/2023
Date Signed: 11/08/2023 05:01:22 PM


Document Has Been Signed on 11/08/2023 05:01 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MARIN YMCA @ MANOR (SA)FACILITY NUMBER:
213000337
ADMINISTRATOR:MARIE-CLAIRE CHOUDHURYFACILITY TYPE:
840
ADDRESS:150 OAK MANOR DRIVETELEPHONE:
(415) 456-5349
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY:70CENSUS: 31DATE:
11/08/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Nicole YetterTIME COMPLETED:
05:20 PM
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On November 8, 2023, Licensing Program Analyst (LPA) Nathan Garcia met with director Nicole Yetter for an unannounced annual inspection for the school aged facility. Purpose of the inspection was explained. There were 31 children and 3 teachers present during the visit. Facility operates day care program Monday- Friday from 1:30 PM through 6:00 PM.

LPA inspected day care room and the outdoor space. LPA observed facility has multiple smoke detectors and carbon monoxide detectors, multiple fully charged fire extinguisher model 3A40BC located on multiple areas. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available in the classroom. The bathroom is in working condition. Individual items provided by the parents are labeled and stored appropriately. According to Nicole, the facility serves two afternoon snacks all prepped on site. Per staff, the children are provided through tap as main source of drinking water, refilled as needed. The kids mainly bring their water bottles from home. All food is stored properly to avoid contamination. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags.

LPA observed multiple outdoor areas and play structures are free from health and safety hazards. The outdoor area has play structures, padded floors with shaded areas for the children to rest. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIN YMCA @ MANOR (SA)
FACILITY NUMBER: 213000337
VISIT DATE: 11/08/2023
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CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE


Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Per director, the facility was tested and have not received the results. According to director, the head of the program is working on getting all the YMCA sites in Marin, San Mateo and San Francisco counties tested and will submit the results to agency as a whole.

According to Nicole, the facility is using Alaris application for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on October 17, 2023. Per Roselle, drills are done at least every 6 months and the school also rotates them between lock down/fire and earthquake drills.

The LPA reviewed the facility records. LPA reviewed 6 children's files during the visit. LPA reviewed 3 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum and schedule posted in the classroom.



The 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.

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIN YMCA @ MANOR (SA)
FACILITY NUMBER: 213000337
VISIT DATE: 11/08/2023
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Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.
LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Incidental Medical Services – IMS. According to staff, there is one with peanut allergy and Epipen is provided by authorized representatives. LPA inspected the medicine and is valid. 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 advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

A copy of this report, and the “Notice of Site Visit” were given to the Director. A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Director, Nicole Yetter.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/08/2023 05:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: MARIN YMCA @ MANOR (SA)
FACILITY NUMBER: 213000337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2023
Plan of Correction
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The director will contact the department of the results once they are received.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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