343624073-4-1-2022-03-CC-MLOR-CCDV2X-20220310150351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624073
Report Date: 03/10/2022
Date Signed: 04/01/2022 01:37:43 PM

Document Has Been Signed on 04/01/2022 01:37 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	YMCA OF SUPERIOR CALIFORNIA - B'NAI ISRAEL		FACILITY NUMBER:	343624073
ADMINISTRATOR:	LESTER, ALISHA		FACILITY TYPE:	840
ADDRESS:	3600 RIVERSIDE BLVD		TELEPHONE:	(916) 562-8048
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 90	CENSUS: 14	DATE:	03/10/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jennifer Moore		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Application Specialist (AS) Mai Lor, and Licensing Program Analysts (LPAs) Alize Tillery and Josiah Gathing met with Applicant Jennifer Moore for the purpose of an announced pre-licensing change of location inspection. The facility was previously licensed under facility #340311102. Applicant request a school-age license to serve 60 school-age children enrolled in Kindergarten and above. Census included 14 children and 3 staff. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 03/02/2022. AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. The facility will provide lunch and AM/PM snacks. INDOOR ACTIVITY SPACE: There are six school-age classrooms: Classrooms #11, #15A, #15B, #17, #18, and #19. AS and LPAs observed sufficient amount of equipment, toys, tables, and storage space. There is a first aid kit in each classroom. Applicant stated medications will stored in the office and inaccessible to children. Applicant stated there are no firearms or weapon on the premises. Applicant stated indoor and outdoor drinking water is provided via sink and a filtered water dispenser located by the play ground structure. Children will bring their own water bottles. Applicant stated the carbon monoxide detector is wired into the fire alarm. AS and LPAs observed a paper sign-in/sign-out system. (Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - B'NAI ISRAEL	FACILITY NUMBER: 343624073
	VISIT DATE: 03/10/2022

NARRATIVE

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AS and LPAs measured the classroom spaces. The total classroom space contains a total of 3066.417 square feet, which will accommodate the requested capacity for 60 school-age children. There is a total of 5 toilets, 2 urinals, and 4 sinks available for children to use in the facility. There is a separate private restroom for the staff. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is an outdoor activity space for school age children. The outdoor play area is surrounded fence that is at least four feet tall. There is a play structure anchored to the ground without safety labels. AS and LPAs observed barks used as cushioned under climbing structure. AS and LPAs observed barks underneath the climbing structure to have been depleted. Applicant was advised to add more barks in areas under sliding areas. AS and LPAs observed sufficient variety of age appropriate equipment and toys. There are shaded areas supplied by trees and overhangs.

AS and LPA measured the outdoor space. The outdoor play area contains a total of 28,010.95 square feet, which will accommodate Applicant's request for 60 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - B'NAI ISRAEL	FACILITY NUMBER: 343624073
	VISIT DATE: 03/10/2022

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Applicant 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.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items are required before a license will be issued:

1. Classrooms that will be utilized for school age children will need to be fully set up

2. Purchased containers with tight fitting lids

3. Add additional barks underneath slides

4. Open-faced heaters shall be made inaccessible to children to ensure children's safety

Exit interview conducted and report was reviewed with Applicant, Jennifer Moore.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

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