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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423040
Report Date: 06/28/2023
Date Signed: 06/28/2023 05:07:42 PM

Document Has Been Signed on 06/28/2023 05:07 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA EASTLAKE CENTERFACILITY NUMBER:
013423040
ADMINISTRATOR:LOVETTE TRAMMELFACILITY TYPE:
850
ADDRESS:1612-45TH AVETELEPHONE:
(510) 370-2966
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 60TOTAL ENROLLED CHILDREN: 45CENSUS: 35DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:36 PM
MET WITH:Jessica BoatnerTIME COMPLETED:
05:15 PM
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On 6/28/2023 at 03:30 PM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required Inspection at YMCA Eastlake Center. LPA met with Center Director, Jessica Boatner and explained the purpose of today's inspection. LPA was granted inspection authority to enter the facility. The facility was toured to conduct a Health and Safety Inspection. Facility's operating days and hours are Monday-Friday 7:30 AM-5:00 PM.

Licensee [or 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.

The physical plant was inspected. LPA toured the premises with the Director.
Indoor space: Facility operates in 3 Rooms - Room 4 (divided into 2 cohorts), Room 5 and Room 6. Room 4A: 1 Teacher and 1 Teacher Aid with 4 children, Room 4B: 2 Teachers with 4 children, Room 5: 2 Teachers and 1 Teacher Aids with 12 children and Room 6: 3 Teachers and 1 Teacher Aid with 15 children. Facility was observed to be in compliance with teacher to children ratio requirement during LPA’s inspection.
The classrooms, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to children in care. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children during today's inspection. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed, all toilets, and hand washing sinks are safe and in sanitary operating condition. All floors were clean and safe.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA EASTLAKE CENTER
FACILITY NUMBER: 013423040
VISIT DATE: 06/28/2023
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Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and free of rodents and other vermin. LPA observed Fire extinguisher, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free. Menus were observed to be posted at least 1 week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days and made available upon request.

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities.


File Review: Children sign in and out procedures and logs were reviewed. All children were signed in by their authorized representative with full legal signatures. A sample of five Children's files and Staff files were taken for review.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

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 Center Director Jessica Boatner.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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