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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406440
Report Date: 07/15/2021
Date Signed: 07/15/2021 01:59:17 PM

Document Has Been Signed on 07/15/2021 01:59 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:BOULDER CREEK YMCA AFTERSCHOOL PROGRAMFACILITY NUMBER:
455406440
ADMINISTRATOR:SWEETWOOD, MARIANNEFACILITY TYPE:
840
ADDRESS:505 SPRINGER DRIVETELEPHONE:
(530) 246-9622
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 90TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marianne SweetwoodTIME COMPLETED:
02:15 PM
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On 7/15/21 at 12:30pm inspection was made to the facility by Licensing Program Analyst (LPA), Snow and met with Marianne Sweetwood. The facility file was reviewed prior to this inspection. A review of the personnel report on 7/12/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was toured at 1pm time inside and outside and the floor and yard plan submitted by the licensee were verified. This program is operated by the Shasta County YMCA on the Boulder Creek Elementary School campus in the gymnasium, cafeteria, library and pods 1, 2 and 3 (office is located in room 65). The facility’s operating hours are during the school year, Monday-Friday 2PM-6PM and during the summertime the facility operates under Exempt care.

There are no pools or similar bodies of water on campus. The Director stated no firearms or weapons are stored on site and none were observed. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. Poisons are locked in the janitor closet. Furniture and equipment are in good condition and free of hazards.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: BOULDER CREEK YMCA AFTERSCHOOL PROGRAM
FACILITY NUMBER: 455406440
VISIT DATE: 07/15/2021
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The outdoor activity space was cushioned with wood chips and free of hazards. Toilets and sinks are in sanitary condition and operating properly. The facility floors were clean and safe. The kitchen/food preparation area is clean, and free of litter or rodents. Food is properly stored and free of contamination. Trash cans have tight fitting lids. Drinking water is available to children both inside dispensers and outside fountains. The facility was free of flies, insects and rodents. The facility has a working carbon monoxide detector.
During today's inspection, staffing ratios were being met and there were zero children were being supervised by zero teachers/aides. Children are not left without visual supervision at any time. The facility was operating within the licensed capacity. At least one staff member present during the visit Director possessed current CPR and First Aid certifications. The sign in/out sheet was reviewed, and representatives are using full signatures and recording the time. Staff are provided on-the-job training, including sanitation and universal precautions. Children with symptoms of illness are not accepted, and children who become ill during the day are isolated in the office. A weekly menu was posted in the hall.
Zero children’s & staff records were reviewed because none were in care. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection. Or The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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