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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000352
Report Date: 10/17/2024
Date Signed: 10/17/2024 05:15:17 PM

Document Has Been Signed on 10/17/2024 05:15 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:YMCA OF SF., RICHMOND BRANCH, ARGONNE SITEFACILITY NUMBER:
384000352
ADMINISTRATOR/
DIRECTOR:		ALEXANDRA ZUSSMANFACILITY TYPE:
840
ADDRESS:680 18TH AVENUETELEPHONE:
(415) 831-4093
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 200TOTAL ENROLLED CHILDREN: 200CENSUS: 40DATE:
10/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Abdulmobdy MonimTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On October 17, 2024, Licensing Program Analyst (LPA) Van conducted an unannounced annual inspection and met with the Site Coordinator, Abdulmobdy Monim. The purpose of the inspection was explained. Mr. Monim informed LPA that the director on file, Alexandra Zussman, had left the Center in 2022. LPA informed Mr. Monim to submit new Director paperwork when the Center hires a new Director. The program was operated at Argonne Elementary School, and the days and hours of operation are Monday to Friday, from 2:40 pm to 6:00 pm.

The site coordinator and LPA inspected the facility for potential health and safety hazards. This school year, the Center uses rooms 201 and 302 and the multi-purpose room. All classrooms are equipped with age-appropriate learning materials and are well-maintained. The rooms have good ventilation and ample lighting. The facility has centralized smoke and carbon monoxide detectors and fully charged fire extinguishers. There are separate boys' and girls' bathrooms, which are observed to be clean and well-sanitized. All solid waste bins have suitable tightly fitted lids. The facility does not have pools, spas, or other bodies of water. Additionally, all cleaning solutions, poisons, and other dangerous chemicals are inaccessible to children.

The outdoor spaces were shared with another two after-school programs with different schedules. The outdoor playground area is well-maintained and fully fenced for supervision. The play structure is suitable for the children's age and in great condition, with soft cushioning underneath to prevent any accidental falls.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
Document Has Been Signed on 10/17/2024 05:15 PM - It Cannot Be Edited


Created By: Brendon Van On 10/17/2024 at 03:56 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, ARGONNE SITE
FACILITY NUMBER: 384000352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

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
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Based on [(observation) (interview) (record review)], the licensee did not comply Based on observation, interviews, and record review, S1 is an uncleared individual directly working with supervising enrolled children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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The Center must ensure that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance. The Site Coordinator stated he would have S1 complete the fingerprint process before having S1 return to the facility and work.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/17/2024 05:15 PM - It Cannot Be Edited


Created By: Brendon Van On 10/17/2024 at 03:56 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, ARGONNE SITE
FACILITY NUMBER: 384000352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the interview and record review, the Center did not comply with the above-referenced section. Water fixtures were not tested for lead before the due date of January 1, 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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Per the Waterboard test result, the Center tested its water on February 23, 2024. As a result, this deficiency cleared today.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the Center did not comply with the abovementioned section. All staff members present during the inspection have not completed their Mandated reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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The Center must ensure that the Mandated Reporter Training is completed every two years and available for review during the inspection. The Site Coordinator states he and all the staff members will conduct the training on or before October 25, 2024. A return visit is necessary to ensure the deficiency has been corrected.
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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


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Document Has Been Signed on 10/17/2024 05:15 PM - It Cannot Be Edited


Created By: Brendon Van On 10/17/2024 at 03:56 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, ARGONNE SITE
FACILITY NUMBER: 384000352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the Center did not comply with the abovementioned section. Two out of four teachers did not have immunization records on file or available for review, including MMR, Tdap, Influenza, and TB clearance, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2024
Plan of Correction
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The Center must ensure that all immunization records for their employees are complete and on file before they start working. The immunization records of the two teachers should also be included in their personnel file by October 25, 2024. A follow-up visit will be conducted to verify that all necessary immunization records exist.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Garfield Leung
LICENSING EVALUATOR NAME:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


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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, ARGONNE SITE
FACILITY NUMBER: 384000352
VISIT DATE: 10/17/2024
NARRATIVE
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The Center will have dedicated staff to pick up the kindergarteners and first graders from their respective classrooms and escort them to the program. The older children will walk to the program by themselves. The staff will sign in all children, and a headcount will be taken before entering the classroom to ensure everyone's safety.

LPA observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). Fire and Earthquake drills are conducted at least once every six months with the last drill conducted on 5/29/2024. However, the drills were not documented. A technical violation was issued.

During today's inspection, LPA reviewed random samples of children's and staff records. All children had medical assessments and the necessary licensing forms on file. Upon reviewing the staff members' records, it was found that one staff member did not have clearance for a criminal record. Furthermore, several staff members lacked immunization records, including MMR, Tdap, TB clearance, influenza, and mandated reporter training.

The incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Childcare Centers Sections 101173 and 101226. When any IMS is provided, an updated 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
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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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, ARGONNE SITE
FACILITY NUMBER: 384000352
VISIT DATE: 10/17/2024
NARRATIVE
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The site coordinator 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 Childcare 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.

LPA reminded the site coordinator that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles.

The site coordinator was informed that the Mandated Reporter can be taken online at www.mandaterreporterca.com. Also, the site coordinator was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA encouraged the site coordinator to visit the CCLD website at www.ccld.ca.gov for licensing regulations and new updates. The site coordinator can also email childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.

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.

CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE. As a result, a deficiency was issued. However, since the Center completed its testing on February 23, 2024, the deficiency has been resolved today.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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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, ARGONNE SITE
FACILITY NUMBER: 384000352
VISIT DATE: 10/17/2024
NARRATIVE
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LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.

See LIC 809D for deficiencies cited today.

A Type “A” violation was issued today. The center is informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the owner. Notice of Site Visit shall remain posted for 30 days.

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

Exit interview conducted and report was reviewed with the site coordinator, Abdulmobdy Monim.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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