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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700556
Report Date: 01/08/2024
Date Signed: 01/08/2024 12:46:29 PM


Document Has Been Signed on 01/08/2024 12:46 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:YMCA OF THE EAST BAY-SIAC EARLY LEARNING CENTERFACILITY NUMBER:
015700556
ADMINISTRATOR:LILLY, DONUELLFACILITY TYPE:
830
ADDRESS:27211 TYRRELL AVENUETELEPHONE:
(510) 640-5836
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:78CENSUS: 31DATE:
01/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Donuell LillyTIME COMPLETED:
01:15 PM
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On January 8, 2023 at 8:30 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Three Year Required Inspection and met with the facility representative, Donuell Lilly. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were 31 infants children present during this inspection and eight (8) additional staff members. The infant program is located on the campus of SIAC Early Learning Center. The program is currently utilizing three (3) classrooms on campus (Room 2), (Room 4), and (Room 9). Also on site is a preschool Component operating out of three (3) classrooms. The hours of operation are Monday through Friday from 7:30AM - 5:00PM. This is a TITLE V Facility.

LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the electronic system. LPA reviewed two (2) children's files and one(1) staff file around 11:30 AM. All staff files have required Health Screening, and Employee Rights, and all children files contains Personal Rights, Parent's Rights, and Identification & Emergency Information. 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.


The three(3) classrooms were inspected around 12:00 PM and teacher child ratio was observed. There are 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 in the director's office, away from other children in care. The center has a working smoke detectors, a carbon monoxide detector, working telephone, and three (3) fully charged 3A40BC fire extinguishers which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 12/18/23. All required documents are posted in a public accessible area.



See 809-C.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY-SIAC EARLY LEARNING CENTER
FACILITY NUMBER: 015700556
VISIT DATE: 01/08/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

This facility provides breakfast, lunch, and snacks for the children. There are weekly menus posted at the facility. Low-fat milk is being served and food/beverages capable of rapid spoiling are properly stored. All storage containers for solid waste have tight fitting covers that are in good repair.

The outdoor area is fully fenced and free of hazards. There are canopies that provide shade to children while at play and the staff brings the children’s water bottles and cups to keep the children hydrated. The play equipment is age appropriate and in good repair. There's a lock shed with equipment on the playground that's off limits to children in care.


The staff's bathroom is separate from the children's bathroom and all of the sinks and faucets are in safe and sanitary operating condition. There's a changing table in arms reach of the faucet and extra clothes and supplies for the children in the class. The children can reach the sinks and toilets and the paper towels and soap are available to the children.

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. LPA reminded the facility representative that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See 809-C

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

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY-SIAC EARLY LEARNING CENTER
FACILITY NUMBER: 015700556
VISIT DATE: 01/08/2024
NARRATIVE
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Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 Donuell Lilly.

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

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3