214005103-1-21-2020-05-CC-ASTR-BL34P6-20200121181613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005103
Report Date: 01/21/2020
Date Signed: 01/21/2020 06:16:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MARIN YMCA @ HIDDEN VALLEY		FACILITY NUMBER:	214005103
ADMINISTRATOR:	JAMES, JORDAN		FACILITY TYPE:	840
ADDRESS:	46 GREEN VALLEY CT.BLDG 5 & 6		TELEPHONE:	(415) 457-4465
CITY:	SAN ANSELMO	STATE: CA	ZIP CODE:	94960
CAPACITY:	80	CENSUS: 34	DATE:	01/21/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:49 PM
MET WITH:	Wayne Everbeck, Area Manager		TIME COMPLETED:	06:30 PM

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	An annual random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This YMCA School-Age program is located on the Hidden Valley Elementary School campus, occupying Room #1 and the Multi-Purpose Room. The facility’s operating hours are 7:00-9:00am and 12:45-6:30pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The Area Manager stated that no poisons are stored on the premises and none were observed during today's inspection. The toys, floors, tables and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children both indoors and outdoors by drinking fountains. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is artificial turf cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The area manager stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 34 children were being supervised by 5 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit, Staff 1 (S1) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Six children’s records were reviewed, and contained signed admission agreements. Two staff records were reviewed at and contained documentation of education and training as required. Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARIN YMCA @ HIDDEN VALLEY	FACILITY NUMBER: 214005103
	VISIT DATE: 01/21/2020

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
26
27
28
29
30
31
32

This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Area Manager. The Area Manager was not aware of a written Plan of Operation in place from the YMCA Branch, and will discuss either obtaining the written plan currently in place or developing a Plan of Operation for providing IMS and submit the plan to the San Bruno RO. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochure, were reviewed and discussed with the area manager. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2