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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700588
Report Date: 10/09/2023
Date Signed: 10/09/2023 12:20:26 PM

Substantiated


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
10/05/2023 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20231005132115
FACILITY NAME:YMCA OF THE EAST BAY-CHERRYLAND ELCFACILITY NUMBER:
015700588
ADMINISTRATOR:MEDINA, ANDREWFACILITY TYPE:
850
ADDRESS:21144 MISSION BOULEVARDTELEPHONE:
(510) 247-8287
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:48CENSUS: 8DATE:
10/09/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Michele FreemanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff does not keep facility free from pests.
INVESTIGATION FINDINGS:
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On October 9, 2023 at 8:15 AM, Licensing Program Analyst (LPA) Elimika Woods arrived to the facility unannounced to conduct an investigation into 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 four additional staff members. LPA informed the facility representative of the reason for visit and toured the facility.

During the course of the investigation, gathered documents, and conducted interviews regarding the allegation that staff does not keep facility free from pests. LPA reviewed an email from the pest control company that stated there's a termite problem at the exposed rafters and framing of the ceiling above the stairwell at the center.

Based on record reviews and interviews It has been disclosed that Clark Pest control company recommended for that species of termites is tent fumigation and would required 2 1/2 day's vacancy and some prep. The allegation has been SUBSTANTIATED. Based on evidence gathered, the standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies cited on 9099D

This report shall remain on file for 3 years. A Notice of Site Visit was provided and must remain posted for 30 days with appeal rights provided. Exit interview conducted with the facility representative, Michele Freeman.
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 52-CC-20231005132115
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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-CHERRYLAND ELC
FACILITY NUMBER: 015700588
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2023
Section Cited
CCR
101238(a)(1)
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Title 22, Division 12 Chapter 1 Article 07. Physical Environment 101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety......
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The facility representative will submit a written plan of correction with methods and procedures to prevent pest infestation to LPA by 11/09/2023 due date via email or mail.
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Based on the LPA obersavations and staff interviews, the condition of the facility indicates that the staff failed to prevent pest infestation.
This requirement was not met as evidence. This poses an immediate risk to the Health, Safety and personal rights of the children in care.

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The facility representative shall contract a pest contol company to prepare the facility and to take measures to prevent pest infestation. The facility representative shall conduct and document a staff meeting and or training on the facility safe, healthful and comfortable accommodations. The facility representative shall forward a copies to LPA by 11/09/23.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC9099 (FAS) - (06/04)
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