414004719-11-8-2021-05-CC-JSAI-C8KSVP-20211108131305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004719
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:13:51 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:	11/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Director Anthony Gianni		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Jyoti Saini met with Director Anthony Gianni for annual random inspection. Purpose of the inspection was explained. LPA did not observe any children in care. LPA and Site Supervisor inspected the day care areas for health and safety hazards. Program operates M-F from 1:30pm -6:00PM. This facility is operating in Room #5 on a functioning school site of Portola Elementary School. There are no pools, spas or other bodies of water at the facility. The Facility has fully charged fire extinguisher. All the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. There are separate bathrooms for boys and girls. 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. Isolation of ill children will be located in a corner area of the classroom #5. Children bring their own water bottles.The facility has garbage cans with tight-fitting lids, first aid and emergency supplies.

Play yard is free of hazards. All the files are complete and up to the date. As per record review, Teacher working in the Classroom have valid CPR card in the file. Staff have documentation of required immunization (measles, pertussis and influenza). Facility conduct the fire and emergency drills monthly. Last fire drill was conducted on 10/04/2021.

Sign-in/Sign out of the children is completed by staff at drop off and pick up.

continue on to the next page...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

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: 11/08/2021

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The facility representative 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.

Continue on next page..Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Anthony Gianni

Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.govi

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC809 (FAS) - (06/04)

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