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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407414
Report Date: 05/22/2023
Date Signed: 05/22/2023 01:03:19 PM

Document Has Been Signed on 05/22/2023 01:03 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 CHILDCARE - GOLDEN VIEWFACILITY NUMBER:
073407414
ADMINISTRATOR:WILLIAMS, JENNIFERFACILITY TYPE:
840
ADDRESS:5025 CANYON CREST DRTELEPHONE:
(925) 735-3981
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 115TOTAL ENROLLED CHILDREN: 103CENSUS: 15DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jennifer WilliamsTIME COMPLETED:
01:01 PM
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On 5/22/2023 at 10:15am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jennifer Williams for an Unannounced Required 1-Year Inspection. During the inspection were fifteen (15) school age children and four (4) staff members. LPA toured one (1) classroom for a health and safety inspection. This is a before and after school facility that operates on the Golden View Elementary School campus in two (2) rooms (YMCA Building and Room 20 on school campus). YMCA currently does not use the room. LPA was not able to tour Room 20 as it is in use by the elementary school until 2:30pm LPA Otsuji conducted an inspection of the room on 2/13/2023. Director informed LPA that the room will be reopened next school year. The facility operates from 6:30am – 6:30pm Monday – Friday.

The facility has ample age-appropriate materials in the classroom that were observed to be clean and in good condition. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. All sinks and toilets are observed to be clean and in proper working order. All children have access to clean drinking water in each classroom. The classroom has a working smoke/carbon monoxide combination detector and a fully charged fire extinguisher. There is a separate staff bathroom on site.

The play yard is shared with the Golden View Elementary School. The play structure is sturdy, anchored into the ground and has sufficient cushioning underneath with shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The food prep area is clean, well maintained, and all hazards are in inaccessible areas. All children bring their lunch, and all snacks are provided by the school. All food is properly labeled and stored. The facility conducts field trips during the summer and uses rented school buses to transport the children. No facility staff drive the buses or transport children.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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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 CHILDCARE - GOLDEN VIEW
FACILITY NUMBER: 073407414
VISIT DATE: 05/22/2023
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The facility is operating within their licensed capacity and is in ratio today. All required postings are made visible on the wall over the sign in/out sheets. All staff working have obtained a criminal record clearance, exemption, or transfer. The fire/disaster drill log is complete with the last drill logged on 5/17/2023. A physical census of the children was taken and cross referenced with the sign-in and out logs. All children have been properly signed in by their parent or authorized representative. LPA obtained a sample of the children’s files, a sample of the staff files, and the facility files. All files were complete.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee 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 Licensee 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA CHILDCARE - GOLDEN VIEW
FACILITY NUMBER: 073407414
VISIT DATE: 05/22/2023
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Director was reminded that all adults 18 and over, 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Jennifer Williams.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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