<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700587
Report Date: 11/15/2022
Date Signed: 11/15/2022 05:45:22 PM

Document Has Been Signed on 11/15/2022 05:45 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA OF THE EAST BAY-CHERRYLAND ELCFACILITY NUMBER:
015700587
ADMINISTRATOR:MEDINA, ANDREWFACILITY TYPE:
830
ADDRESS:21144 MISSION BOULEVARDTELEPHONE:
(510) 247-8287
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 0DATE:
11/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Monica Williams & Andrew MedinaTIME COMPLETED:
06:05 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
On 11/15/2022, a Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Area Manager, Monica Williams and Center Director, Andrew Medina. The applicant has submitted an application for an INFANT license with the option to have up to 16 toddlers (18 months- 36 months) in the toddler-option room. A health and safety inspection was conducted inside and outside. The infant program will operate in 3 classrooms (Infant, Toddler 1A/1B & Toddler 2). Also on site is a Preschool Component operating out of 3 classrooms (Classroom 1-3). Operation hours are Monday through Friday from 7:30AM - 5:00PM. This is a TITLE V Facility. The measurements are as follows:

INDOORS: 1741.11 square feet = 49 children
OUTDOORS: 2554.09 square feet = 34 children

Classrooms are equipped with varied age appropriate materials and equipment. There are multiple changing tables within arms reach of a sink. The facility has the option to enroll up to 9 crib-aged children enrolling into the infant component. There are 12 sinks located within the classrooms. Office and staff bathroom will serve as isolation area for ill children and either floor. There is a total of 2 play yards for the infant aged children to utilize one of which is for toddlers. The infant yards are barricaded to prevent commingling with preschool aged children. Canopies provide sufficient shade in all play yards. Facility will have AM/PM snacks and catered lunch for children. Cabinets with cleaners are locked and/or inaccessible to prevent access to children. Facility will utilize electronic sign in and out. The system allows for a unique identifier and records the date and time of day.
This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY-CHERRYLAND ELC
FACILITY NUMBER: 015700587
VISIT DATE: 11/15/2022
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
The center has received an approved fire clearance from Alameda County Fire Department on 11/10/2022.

Andrew Medina is a fully qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid. Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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. LPA also informed applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A license for 34 infant aged children which includes the option to have up to 16 toddlers in the toddler option program (operating out of 3 rooms - Infant Room, Toddler 1A/1B, and Toddler 2) will be issued effective today, 11/15/2022.



Exit interview conducted with facility representative, Monica Williams.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2