414004719-9-24-2020-05-CC-AROZ-BTRV7X-20200924161152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004719
Report Date: 09/24/2020
Date Signed: 09/24/2020 04:11:57 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:	YMCA OF SF-PENINSULA BRANCH-PORTOLA ASP		FACILITY NUMBER:	414004719
ADMINISTRATOR:	SENORES, ANNE		FACILITY TYPE:	840
ADDRESS:	300 AMADOR AVENUE		TELEPHONE:	(670) 286-9622
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	75	CENSUS: 0	DATE:	09/24/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Anne Senores		TIME COMPLETED:	03:15 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	Licensing Program Analysts (LPA) Rodriguez met with applicant Anne Senores for a Pre-licensing inspection of the facility via Google Duo. Due to the COVID -19 outbreak and current shelter in place orders in the State of California and San Mateo County, the pre-licensing inspection was conducted via tele-inspection on September 24, 2020. The facility was inspected today, indoor and outdoor, for health and safety hazards. This facility will be located on a functioning school site of Portola Elementary School. The applicant is requesting a capacity for 75 school aged children (ages 5 years old to 11 years old) in rooms 1-5 of the North, East, and West wings. In addition care will be given to the children in the cafeteria, multipurpose rooms, library, work room, blacktop and other main play yard. Children will have access to bathrooms located on the school site as well. The facility will operate Monday - Friday; 8:00 AM to 9:30 AM and then again from 1:30 PM to 6:30 PM. Since the school age program is operated on a functioning elementary school site, the program is exempt from outdoor square footage requirements, fencing requirements, toilet/sink ratios, isolation requirements and indoor square footage requirements. No measurements were taken today. The school age children will have use of the elementary school playground and outside bathrooms which provide individual privacy. Staff will escort children to and from the bathrooms located on the campus of the elementary school and will ensure the bathrooms are clean and safe prior to being used by any children. Continued on next page.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF-PENINSULA BRANCH-PORTOLA ASP	FACILITY NUMBER: 414004719
	VISIT DATE: 09/24/2020

NARRATIVE

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The indoor spaces for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings located outside of the classrooms. The indoor space is equipped with a fire alarm system and carbon monoxide detectors. All food and snacks will be kept in the cafeteria areas. Water will be provided to the kids by use of water fountains or personal water fountains. Each room has garbage cans with tight-fitting lids, first aid and emergency supplies.

Sign-in/Sign out of the children will be completed by staff at drop off and pick up. The program also utilizes an agreement for alternative arrival and release of children from the program for children whose parents have authorized leaving the program on their own, or arriving on their own. The bathrooms were observed to be clean and with no health and safety hazards. Bathrooms are located on the school campus outside of the proposed rooms to be used. There are sinks for children located in work room and bathrooms for children to use. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located either in a corner area of the classroom and staff bathroom will be used for the child until the parent arrives for pick up.

The outdoor area was observed to be clean, safe and equipped with toys and equipment for children. Since the outdoor space is used for elementary school children as well as children that will be in this licensed after school care program, the applicant will ensure close supervision of the children and ensure there is not commingling of children from the elementary school and community in general, and the children participating in this after school care program. Personal bottled water will be used for drinking water outside or use of a water fountain. Shade for children is provided by shade structures.

Continued on next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF-PENINSULA BRANCH-PORTOLA ASP	FACILITY NUMBER: 414004719
	VISIT DATE: 09/24/2020

NARRATIVE

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Applicant will ensure all required postings are posted and visible to parents. The facility will conduct monthly disaster drills and a log will be maintained for review upon request.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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

At this time, a license cannot be recommended until the licensing department receives a granted STD 850 Fire Clearance Request Form along with a completed Attestation Form for a Waiver. A copy of this report will be sent to Anne Senores via email.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Adam Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC809 (FAS) - (06/04)

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