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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700588
Report Date: 03/01/2024
Date Signed: 03/01/2024 02:46:39 PM

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
02/20/2024 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20240220110137
FACILITY NAME:YMCA OF THE EAST BAY-CHERRYLAND ELCFACILITY NUMBER:
015700588
ADMINISTRATOR:FREEMAN, MICHELEFACILITY TYPE:
850
ADDRESS:21144 MISSION BOULEVARDTELEPHONE:
(510) 247-8287
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:48CENSUS: 15DATE:
03/01/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Michele FreemanTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical Plant-Facility is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On March 1, 2024 at 1:20 PM, Licensing Program Analyst (LPA) Elimika Woods arrived to the facility unannounced to conclude an investigation into the above allegation. Upon arrival LPA was allowed in by the facility representative, Michele Freeman. Present during the visit were 15 preschool age children and three additional staff members. LPA informed the facility representative of the reason for visit and toured the facility.

Based on the interviews, record review, and observations conducted, this agency has investigated the complaint that facility is in disrepair and the LPA determined that the complaint was UNSUBSTANTIATED, meaning that 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, therefore, 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:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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
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
02/20/2024 and conducted by Evaluator Elimika Woods
COMPLAINT CONTROL NUMBER: 52-CC-20240220110137

FACILITY NAME:YMCA OF THE EAST BAY-CHERRYLAND ELCFACILITY NUMBER:
015700588
ADMINISTRATOR:FREEMAN, MICHELEFACILITY TYPE:
850
ADDRESS:21144 MISSION BOULEVARDTELEPHONE:
(510) 247-8287
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:48CENSUS: 15DATE:
03/01/2024
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Michele FreemanTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical Plant-Facility has mold.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On March 1, 2024 at 1:20 PM, Licensing Program Analyst (LPA) Elimika Woods arrived to the facility unannounced to conclude an investigation into the above allegation. Upon arrival LPA was allowed in by the facility representative, Michele Freeman. Present during the visit were 15 preschool age children and three additional staff members. LPA informed the facility representative of the reason for visit and toured the facility.

Based on the interviews, record reviews, and observations conducted, this agency has investigated the complaint that facility has mold and the LPA determined that the complaint was UNSUBSTANTIATED, meaning that 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, therefore, 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: 15
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2