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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411575
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:19:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA @ OAK ELEMENTARYFACILITY NUMBER:
434411575
ADMINISTRATOR:KIERRA MCCLANAHANFACILITY TYPE:
840
ADDRESS:1501 OAK AVENUETELEPHONE:
(650) 969-6865
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:60CENSUS: 13DATE:
10/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Lourdes NaneviczTIME COMPLETED:
03:35 PM
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On October 21, 2021 at 1:25 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with Director, Lourdes Nanevicz. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Director. There were thirteen (13) children present during this inspection and two additional staff members. The facility consists of one (1) classroom. The facility was toured for a health and safety inspection and the hours of operation are 2:00 PM-6:00 PM, Monday -Friday

CLASSROOMS: The one classroom was inspected which has adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is next to director's desk, away from other children in care. The center has a smoke detector, a carbon monoxide detector, working telephone, pull down fire alarm system, and one 1) fully charged 3A40BC fire extinguisher.

BATHROOMS AND TOILETING AREAS: The staff use's a part of the boys bathroom for their bathroom needs. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children.

FOOD SERVICE AREAS: This facility provide snacks for the children. There are weekly menus posted at the facility. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents. All storage containers for solid waste have tight fitting covers that are in good repair.

See 809-C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA @ OAK ELEMENTARY
FACILITY NUMBER: 434411575
VISIT DATE: 10/21/2021
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OUTDOOR PLAY AREAS: The centers uses the Oaks Elementary School playground after school ends. There's a play structure with a slide and a swing that is anchored that has cushioning to absorb falls. There's a canopy and trees that provides shade to children while at play. The children have water bottles while at play and water is provided in a pitcher bottle.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Four (4) children's files and one (1) staff file was reviewed around 2:15 PM. All staff files have required Health Screening, and Employee Rights and all children's files contains, Personal and Parents Rights, Medical Consent forms, and Identification & Emergency forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. Director's CPR and First Aid certificate is current and expires on 09/5/2023. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months and the last one was conducted on 09/29/21. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: There's no IMS being provided at this time and no medication being stored at the facility. The center is equipped with a fully stocked first aid kit that is available in the classroom.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

See 809-C.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA @ OAK ELEMENTARY
FACILITY NUMBER: 434411575
VISIT DATE: 10/21/2021
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LPA discussed the safe sleep regulations with facility representative 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 facility representative 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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



To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Lourdes Nanevicz

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3