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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408943
Report Date: 06/23/2023
Date Signed: 06/23/2023 06:09:45 PM


Document Has Been Signed on 06/23/2023 06:09 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:YMCA OF THE EAST BAY - FAIRGROUNDS ELCFACILITY NUMBER:
073408943
ADMINISTRATOR:RAMONA CARRILLOFACILITY TYPE:
850
ADDRESS:1203 WEST 10TH STREETTELEPHONE:
(925) 450-6952
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:128CENSUS: 25DATE:
06/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shekinah SudduthTIME COMPLETED:
05:00 PM
NARRATIVE
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On 06/23/2023 at 2:15 PM, Licensing Program Analyst (LPA) Christina Watts conducted a Case Manager Inspection at YMCA of the East Bay - Fairgrounds ELC. LPA met with Lead Teacher, Shekinah Sudduth and explained the purpose of this visit. Director, Ramona Carrillo was not present during this inspection. Lead Teacher took LPA on a tour of the facility. There were 25 preschool aged children in care with 6 staff. Lead Teacher stated they are 37 preschool children enrolled.

LPA was following up on a self reported incident that the facility reported to licensing on 05/26/2023. Facility reported that P1 was being disruptive and violent toward S1 while picking up C1 from the facility. LPA toured the facility, observed classrooms, reviewed files, conducted interviews and obtained relevant documents. Based on information obtained, this allegation NEEDS FURTHER INVESTIGATION.

During inspection, it was determined that employee ROSA ISELA RUIZ who was present and providing supervision to children, was not associated to facility license. She was associated to the facility, however disassociated on 04/04/2023. She has active eligible clearance to another licensed childcare facility.
LPA Christina Watts assessed a civil penalty of $100 for employee supervising and caring for children without a current association to facility. Facility was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed 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. *SEE LIC 809-D FOR DEFICIENCIES*
Exit interview conducted and report was reviewed with Shekinah Sudduth. A notice of site visit was given and must remain posted for 30 consecutive days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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Document Has Been Signed on 06/23/2023 06:09 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: YMCA OF THE EAST BAY - FAIRGROUNDS ELC
FACILITY NUMBER: 073408943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2023
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review [...] shall prior to working, residing or volunteering in a licensed facility
(2) Request a transfer of a criminal record clearance. This requirement is not met as evidenced by:
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BY COB 06/28/2023, facility will have Rosa associated to facility. Facility will submit proof to licensing that Rosa has been associated.
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employee ROSA ISELA RUIZ was present today,providing supervision to children, was not associated to facility license. She has active eligible clearance to another licensed childcare facility. Civil penalty $100 assessed for 1 day.
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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.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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