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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504578
Report Date: 05/21/2024
Date Signed: 05/23/2024 09:43:57 AM

Document Has Been Signed on 05/23/2024 09:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITEFACILITY NUMBER:
380504578
ADMINISTRATOR/
DIRECTOR:		ALEXANDRA ZUSSMANFACILITY TYPE:
840
ADDRESS:4545 ANZA STREETTELEPHONE:
(415) 317-4882
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 200TOTAL ENROLLED CHILDREN: 86CENSUS: 55DATE:
05/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Alicia BrennnanTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the Site Coordinator, Alicia Brennan & the interim Site Director, Grace Toyomura, and explained the purpose of the inspection to them. There were 55 children with 7 staff presents. The program was operated in a functioning school site Lafayette Elementary School. The YMCA office is located and shared with another afterschool program at the bottom of the classroom building. All the following rooms are licensed for this program: 036A, 036B, 36C, 037B, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 126, 128, 131, 133, 133A, 218, 224, and 229. The program runs in the rooms 104,106, 111, 214, 218, 220, 223, Library, music room, multi-purpose room and outdoor play yards for this school year. Facility met teacher/child ratio. LPAs inspected the facility for health and safety hazards. Variety of age-appropriate learning materials equipment & children's furniture that were in good condition and repaired were available in each classroom. Toxins and harmful objects were kept inaccessible to children. The center provided snacks only to children. Per site director, SFUSD also provided the supper meals to the after-school children. First aid supplies were available in the YMCA classroom. Water fountains and water bottle refill fountains were available on campus. The outdoor playground was completely fenced. There were some climbing and slide structure with soft cushioning underneath & basketball courts available for the children. At least 5 staff had current pediatric CPR and First Aid training available during the inspection. The CPR/First Certificate will expire in 4/2026. Fire drill has done at least every six month and were properly logged. LPA reviewed the staff and children’s files during the inspection. Per Alicia, there were no children on special medication. The facility passed the Lead Water Test that must be done every 5 years.

continues in LIC 809C.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITE
FACILITY NUMBER: 380504578
VISIT DATE: 05/21/2024
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Criminal Record Clearance - Child Care Centers Licensee [or facility representative] was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP Page Four For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) - Child Care Centers
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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITE
FACILITY NUMBER: 380504578
VISIT DATE: 05/21/2024
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Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit Interview - Exit interview conducted and report was reviewed with the Site Director, Grace Toyomura.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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