015700588-9-6-2023-52-CC-CCHS-CVNSTZ-20230914141022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015700588
Report Date: 09/06/2023
Date Signed: 09/06/2023 09:05:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2023 and conducted by Evaluator Elimika Woods

COMPLAINT CONTROL NUMBER: 52-CC-20230623161807

FACILITY NAME:	YMCA OF THE EAST BAY-CHERRYLAND ELC		FACILITY NUMBER:	015700588
ADMINISTRATOR:	MEDINA, ANDREW		FACILITY TYPE:	850
ADDRESS:	21144 MISSION BOULEVARD		TELEPHONE:	(510) 247-8287
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	48	CENSUS: 8	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Michele Freeman		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Physical Plant-Black Widow spiders are present everywhere in the playground area.

INVESTIGATION FINDINGS:

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THIS IS AN AMENDED REPORT OF THE ORIGINAL LIC 9099A ON AUGUST 16, 2023.

On September 6, 2023 at 8:30 AM, Licensing Program Analyst Elimika Woods arrived to the facility unannounced to delivery the finding for the above allegation. Upon arrival LPA was allowed in by the facility representative Michele Freeman. Present during the visit were eight preschool age children and 5 additional staff members. LPA informed the facility representative of the reason for the visit and toured the facility.

Based on the interviews and documents received, this agency has investigated the complaint that Black Widow spiders are present everywhere in the playground area and the LPA determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefor, the allegation is UNSUBSTANTIATED.

Exit interview conducted with Michele Freeman, appeal rights and notice of site visit was provided and must remain posted for a period of 30 days.

Unsubstantiated

Estimated Days of Completion: 1

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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