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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573601605
Report Date: 11/22/2019
Date Signed: 11/22/2019 02:27:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:YMCA OF THE EAST BAY-WINTERSFACILITY NUMBER:
573601605
ADMINISTRATOR:URIBE, JESSICAFACILITY TYPE:
850
ADDRESS:100 MYRTLE AVETELEPHONE:
(530) 795-5065
CITY:WINTERSSTATE: CAZIP CODE:
95694
CAPACITY:49CENSUS: 33DATE:
11/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Director- Jessica UribeTIME COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Silva met with Director Jessica Uribe for the purpose of an unannounced case management inspection. Upon arrival, there were seven staff and 33 children present. The purpose of the inspection was in follow up to the Unusual Incident Report (UIR) that was submitted by the facility to Community Care Licensing on November 6, 2019. The UIR was for an incident that occurred on November 5, 2019 when a parent observed Teacher (T1) grab child (C1) by the arm to sit the child down. It was stated by (T1) that she was guiding (C1) to circle time by lightly holding onto (C1's) arm. (T1) stated that she didn't aggressively grab the child. Director stated that at the time of the incident the only adults present in that classroom were the parent and (T1). Director also stated that due to this incident the facility had a staff meeting on November 6, 2019 and a staff training on November 15, 2019 regarding personal rights and strategies for discipline. Director stated that further measures have been taken to ensure these strategies are being used. LPA Silva interviewed the Director and teacher (T2), reviewed staff files and obtained the facility personnel roster. LPA Marissa Soto will interview (T1) and the parent by phone on November 25, 2019 and will follow-up with Director later that day.

An exit interview was conducted with Director. No deficiencies were cited. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review and appeal rights were provided.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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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