340311130-10-29-2024-03-CC-DVAG-DAHTR3-20241029145652

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340311130
Report Date: 10/29/2024
Date Signed: 10/29/2024 02:56:57 PM

Document Has Been Signed on 10/29/2024 02:56 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	YMCA OF SUPERIOR CALIFORNIA - CDC INFANT		FACILITY NUMBER:	340311130
ADMINISTRATOR/ DIRECTOR:	MELIA SAVAGE		FACILITY TYPE:	830
ADDRESS:	1926 V STREET		TELEPHONE:	(916) 457-9622
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 9	DATE:	10/29/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Jessica Thomas		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

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At 9:00 p.m. on Tuesday, October 29th, 2024, Licensing Program Analyst (LPA) Pa Dao Vang Director Jessica Thomas, for the purpose of an unannounced, required annual inspection. LPA observed a census of 9 infants supervised by 3 staff. Facility hours of operation are from 7:00 a.m. - 6:00 p.m., Mondays thru Fridays. Facility don't provide transportation for the children.

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 conducted a health and safety inspection of the classroom and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Lead Poising information, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Licensee stated that there is no smoking, no firearms nor poisons on the premises.

Furniture and equipment are in good condition. Drinking water is accessible via water bottles and water filter container.

Continue LIC809-C...

Seychelle De Luca	TELEPHONE: (916) 263-5719
Dao Vang	TELEPHONE: (916) 216-7798
	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - CDC INFANT	FACILITY NUMBER: 340311130
	VISIT DATE: 10/29/2024

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Infant under a year old, parents/guardians provide formula from home. For children over 1 years old, facility provides breakfast, lunch, and afternoon snack. Other food in the facility was stored to prevent contamination in the fridge located in the kitchen with proper labels. Facility utilizes an electronic sign in and sign out program to sign children into the facility daily. They also use this electronic app to communicate with parents about children’s day.

LPA observed and reviewed a child's a Needs and Service plan. LPA observed an Individual Infant Sleep Plan (LIC9227) for each child under 12 months of age. LPA observed documentation that sleep checks were being conducted by staff every 15 minutes for all children under 2 years. Bottles and baby food were kept in refrigerator inside the classrooms and were properly labeled with the child’s name and date. All furnishings were in good condition. Infant diaper changing area is clean. Changing table was observed to be within arm’s reach from sink. There is a mat for the changing table with vinyl surface that is at least 1 inch think and has raised sides. Toys are appropriate size with no small parts for the safety of infants.

Facility provides Incidental Medical Services. 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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. Outdoor shade was provided by wooden canopy, trees, and buildings. Water is accessible via labeled bottles, pitchers, and cups.

Continue LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - CDC INFANT	FACILITY NUMBER: 340311130
	VISIT DATE: 10/29/2024

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LPA reviewed staff and a child's records. Each child's file contained an admission agreement, emergency card, health history, immunization, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed health screening, employee rights, immunization, and documentation of the educational background, training, and/or experience.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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 childcare 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). Director stated the facility completed leading testing last year in 2023 with no lead exceedance. Director will locate and email a copy of the lead testing results. LPA obtained a copy of the lead testing results completed on March 16, 2020, with no lead exceedance. Director is working on renewing the Lead Testing by the end of this year and will email LPA the new results.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiency is being cited today in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Director, Jessica Thomas. Appeal rights and a notice of site visit were provided. Notice of site visit shall remain posted for a period of 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC809 (FAS) - (06/04)

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