380504578-3-26-2025-05-CC-HLEG-DF63X7-20250326183753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504578
Report Date: 03/26/2025
Date Signed: 03/26/2025 06:38:03 PM

Document Has Been Signed on 03/26/2025 06:38 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITE		FACILITY NUMBER:	380504578
ADMINISTRATOR/ DIRECTOR:	JAZZY MENDOZA		FACILITY TYPE:	840
ADDRESS:	4545 ANZA STREET		TELEPHONE:	(415) 916-6580
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY: 200	TOTAL ENROLLED CHILDREN: 106	CENSUS: 64	DATE:	03/26/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:45 PM
MET WITH:	Alicia Brennnan		TIME VISIT/ INSPECTION COMPLETED:	06:45 PM

NARRATIVE

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On March 26, 2025, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit. LPA met with Site Coordinator Alicia Brennan and explained the purpose of the visit.

Today's visit included 64 school-aged children and 7 staff members.

LPA confirmed that six staff members had obtained criminal record clearances from the California Department of Social Services. LPA looked in the Guardian Background Check System and did not locate the seventh staff member (S7) in the system. Therefore, S7 did not receive criminal record clearance from California Department of Social Services. The facility is within capacity limits and meets the required ratios for today's visit.

LPA found that all necessary documents were displayed for public viewing. This includes the facility license, notifications of parents’ rights, personal rights, car seat laws, and the emergency disaster plan.

The facility is equipped with first aid kits, a centralized smoke detector, carbon monoxide detectors, and fully charged fire extinguishers.

LPA inspected the indoor and outdoor areas for health and safety hazards. The facility was clean, safe, and well-maintained. Disinfectants, cleaning solutions, and toxic substances were stored in locations inaccessible to children. All accessible cabinets and drawers in the classrooms were free of hazardous materials.

LPA observed that the classrooms had toys, furniture, and learning materials suitable for the children's age. The bathrooms were clean, fully functional, and equipped with the necessary toilets and sanitation supplies.

See Page 2

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITE	FACILITY NUMBER: 380504578
	VISIT DATE: 03/26/2025

NARRATIVE

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The play equipment is in good condition and does not have sharp, loose, or pointed parts. There are no pools, spas, or bodies of water on the property. Drinking water fountains were available in the outdoor activity area.

The director said the facility provides a late lunch and snacks for the children. There are no documented allergies among any of the enrolled children.

LPA reviewed the files of five children and confirmed that each file contains emergency identification information,

LPA reviewed the files of five staff members and confirmed that two had current Pediatric First Aid and CPR certifications, while three did not. The facility had at least one staff member on-site with a current Pediatric First Aid/CPR certification, which meets the childcare regulations.

LPA Leong informed facility representative, Alicia Brennan that this report dated 3/26/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Leong informed the facility representative to provide a copy of this licensing report dated 3/26/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A $100 civil penalty was issued to the facility during today's visit.

This visit will continue at a later date.

Please refer to LIC 809D for today’s deficiency.

Appeal Rights were given to the facility representative, Alicia Brennan

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Alicia Brennan

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Hanson Leong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/26/2025 06:38 PM - It Cannot Be Edited

Created By: Hanson Leong On 03/26/2025 at 06:16 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF., RICHMOND BRANCH, LAFAYETTE SITE	FACILITY NUMBER: 380504578
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. S7 did not have criminal record clearance, which poses an immediate health, safety or personal rights risk to children in care.
	POC Due Date: 03/27/2025
	Plan of Correction
1 2 3 4	S7 must go to a live scan location to complete her fingerprints and wait for criminal record clearance from the California Department of Social Services.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Garfield Leung
NAME OF LICENSING PROGRAM MANAGER:

	Hanson Leong
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC809 (FAS) - (06/04)

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