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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504578
Report Date: 04/20/2022
Date Signed: 04/20/2022 03:01:02 PM


Document Has Been Signed on 04/20/2022 03:01 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITEFACILITY NUMBER:
380504578
ADMINISTRATOR:ALEXANDRA ZUSSMANFACILITY TYPE:
840
ADDRESS:4545 ANZA STREETTELEPHONE:
(415) 317-4882
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:200CENSUS: 71DATE:
04/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Alaxandra Zussman and Gaelle JeuneTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Mok conducted an announced annual inspection today. LPA met with the Site Director, Alexandra Zussman, and Site Coordinator, Gaelle Jeune, The purpose of the inspection was explained to them. There were 71 children with 5 staff present. The program was operated in a functioning school site Lafayette Elementary School. The YMCA office was located at the bottom of the classroom building. All the following rooms were licensed for this program: 036A, 036B, 36C, 037B, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 126, 128, 131, 133, 133A, 218, 224, and 229.. The program was run in the rooms 110, 214, 104, 221, and multi-purpose room for this school year. Facility met teacher/child ratio. LPAs inspected the facility for health and safety hazard. Variety of age appropriate toys and materials for children were available in the classroom. Classrooms were set up for childcare, furniture and equipment for children were available as well. Toxins and harmful objects were kept inaccessible to children. The center provided snacks only to children. Per site director, SFUSD also provided the supper meals to the afterschool children. First aid supplies were available in the YMCA classroom. Water fountains and water bottle refill fountains were available on campus. At least 2 staff had current pediatric CPR and First Aid training available during the inspection. Facility has posted the required forms. Fire drill has done at least every six month and were properly logged. LPA reviewed the staff and children’s files during the inspection. The outdoor playground was completely fenced. Per Site Coordinator, some of the children attended to another activity off-site after school for hours, they might return to school afterward. YMCA’s staff sign the children in when they showed up for the program.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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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