493009730-1-27-2022-01-CC-ASTR-CB43EU-20220127171143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009730
Report Date: 01/27/2022
Date Signed: 01/27/2022 05:11:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	SONOMA COUNTY FAMILY YMCA		FACILITY NUMBER:	493009730
ADMINISTRATOR:	JEREMY HODGDON		FACILITY TYPE:	830
ADDRESS:	2590 PINER ROAD		TELEPHONE:	(707) 308-3043
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	20	CENSUS: 12	DATE:	01/27/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Traci Imm		TIME COMPLETED:	05:20 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 Analyst (LPA) Amy Strother arrived at the facility for the purpose of reactivating the facility license due to the license being on inactive status for a period of time. LPA met with Center Director, Traci Imm (D1). LPA confirmed on 01/27/22 that Annual licensing fees are paid and current. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. D1 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.

This center is an infant center with a toddler component. LPA confirmed that toddlers have a separate activity area from infants. During today’s visit the facility was toured and the facility sketch verified. Operating hours are 7:00am – 6:00pm Monday – Friday. 1 staff was providing care and supervision to 3 infants in the infant area, and 3 staff were caring for and supervising 9 toddlers in the toddler area, operating within the licensed capacity and ratio requirements. At least one staff, Staff 1 (S1) present during the inspection possessed current CPR and First Aid certifications, which expires on 04/30/2023. LPA obtained a current roster of children in care, and updated LIC500, LIC610, and LIC308. LPA verified that the facility has a current fire extinguisher; rated at least 2A10BC, functioning smoke alarm and carbon monoxide detector.

During the visit, LPA Strother discussed the safe sleep regulations with D1 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.

Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SONOMA COUNTY FAMILY YMCA	FACILITY NUMBER: 493009730
	VISIT DATE: 01/27/2022

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
26
27
28
29
30
31
32

LPA also informed D1 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview conducted and report was reviewed with facility representative, Traci Imm.

License will be active effective 01/03/22.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2