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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211880
Report Date: 04/21/2026
Date Signed: 04/21/2026 08:35:59 PM

Document Has Been Signed on 04/21/2026 08:35 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:YWCA OF CONTRA COSTA - HIDDEN VALLEYFACILITY NUMBER:
070211880
ADMINISTRATOR/
DIRECTOR:		MILLER, LISAFACILITY TYPE:
840
ADDRESS:510 GLACIERTELEPHONE:
(925) 374-2838
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 24TOTAL ENROLLED CHILDREN: 27CENSUS: 23DATE:
04/21/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Michelle WatsonTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 04/21/2026 at 2:45 PM, Licensing Program Analyst (LPA) Christina Watts conducted an Case Management Inspection regarding an alleged personal rights violation at YWCA of Contra Costa - Hidden Valley. LPA met with Assistant Executive Director of Child Care, Michelle Watson and explained the purpose of today's inspection. During today's inspection, there were 27 school age children with 2 staff in 1 classroom. Director stated there are 27 school age children enrolled.

LPA is following up on an self reported Unusual Incident Report submitted to licensing on 04/01/2026. LPA toured the facility, observed classrooms, reviewed files, and obtained relevant documents. Per documents received, on 04/01/2026, the classroom was playing outside. Documents stated the Director seen C1 with bruising on their eye and asked what happened. Documents stated C1 said told the Director they were pushing their stuffy on the swing and the swing hit their eye. Documents states the Director asked C1 why they did not tell the teacher and C1 said they don't know. Documents state that their were 2 staff outside and staff did not observe the incident occur. LPA has recommended that the facility have more staff in the afternoon to ensure quality supervision and care. California code of Regulations, Title 22 stated that staff are to supervise children at all times. Also, documentation shows that the incident occurred on 04/01/2026 and the facility reported the incident to licensing on 04/03/2026. California code of regulations, Title 22 states when an incident occurs at a facility during operational hours, the facility is required to report an incident within 24 hours of occurrence or knowledge of occurrence.

LPA Christina Watts informed Assistant Executive Director of Child Care, Michelle Watson that this report dated 04/21/2026 documents 2 Type B citations. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care. *SEE LIC 809-D FOR DEFICIENCIES* *CON'T ON PAGE 2*
NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Christina Watts
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YWCA OF CONTRA COSTA - HIDDEN VALLEY
FACILITY NUMBER: 070211880
VISIT DATE: 04/21/2026
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*PAGE 2*

Exit interview conducted and report was reviewed with the Assistant Executive Director of Child Care, Michelle Watson. A Notice of Site Visit was given and must remain posted for 30 consecutive days.
NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Christina Watts
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/21/2026 08:35 PM - It Cannot Be Edited


Created By: Christina Watts On 04/21/2026 at 05:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: YWCA OF CONTRA COSTA - HIDDEN VALLEY
FACILITY NUMBER: 070211880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
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By 04/28/2026, Assistant Executive Director of Child Care stated they will submit a written statement on how facility will come back into compliance. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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This requirement has not been met as evidenced by: Based on record review, the licensee did not comply with the section cited above when a child was injured due to lack of supervision which poses an potential risk to the health, safety or personal rights of children in care.
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Type B
04/28/2026
Section Cited
CCR101212(d)

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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center...a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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By 04/28/2026, Assistant Executive Director of Child Care stated they will submit a written statement on how facility will come back into compliance. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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This requirement has not been met as evidenced by: Based on record review, the licensee did not comply with the section cited above when the facility failed to report an incident to licensing within 24 hours of occurence which poses an potential risk to the health, safety or personal rights of children.
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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.
Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:
Christina Watts
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2026


LIC809 (FAS) - (06/04)
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