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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570305378
Report Date: 04/11/2023
Date Signed: 04/11/2023 12:31:50 PM

Document Has Been Signed on 04/11/2023 12:31 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:YMCA OF SUPERIOR CALIFORNIA-YOLO PRESCHOOLFACILITY NUMBER:
570305378
ADMINISTRATOR:KATIE GUINANFACILITY TYPE:
850
ADDRESS:1300 COLLEGE STREETTELEPHONE:
(530) 662-1086
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 69TOTAL ENROLLED CHILDREN: 69CENSUS: 22DATE:
04/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cathlean RipleyTIME COMPLETED:
12:45 PM
NARRATIVE
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On April 11th, 2023, at 9:00 am, Licensing Program Analysts (LPAs), Lauren Scott and David Nguyen conducted an announced field visit to the facility. LPAs arrived at the facility and was met by Director Cathlean Ripley (D1). LPAs disclosed the purpose of the inspection and were granted entrance into the facility. LPAs toured the facility and observed twenty-two (22) children being supervised by two (2) adult teachers. LPAs determined through accessing Guardian that two (2) of the teachers were not cleared and/or associated to the facility. Based on observation and review, D1 did not ensure a criminal record clearance and/ or association of the two (2) staff members to her facility, which poses an immediate health, safety or personal rights risk to persons in care.

A Type A violation was assessed on a subsequent 809-D page. An exit interview was conducted, and the report was reviewed with D1. Licensee Appeal Rights were provided to D1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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 04/11/2023 12:31 PM - It Cannot Be Edited


Created By: David Nguyen On 04/11/2023 at 11:48 AM
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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA-YOLO PRESCHOOL
FACILITY NUMBER: 570305378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2023
Section Cited
CCR
101170(e)(1)

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101170 Criminal Record Clearance...
(e) All individuals subject to a criminal record review... prior to working...(1) Obtain a California clearance or a criminal record exemption as required by the Department...This requirement was not met as evidenced by:
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Director will either associate the employees to the facility by transferring the fingerprint clearances or by obtaining new fingerprint clearances.
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Based on record review and interview, the
two (2) staff members were not fully cleared nor associated to the facility which poses an immediate risk to children in care.
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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:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
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