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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408945
Report Date: 10/14/2022
Date Signed: 10/14/2022 11:34:10 AM

Document Has Been Signed on 10/14/2022 11:34 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA OF THE EAST BAY - BELSHAW ELCFACILITY NUMBER:
073408945
ADMINISTRATOR:IMELDA MORENOFACILITY TYPE:
850
ADDRESS:2801 ROOSEVELT LANETELEPHONE:
(925) 450-6950
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 3DATE:
10/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Birdie WinrowTIME COMPLETED:
12:00 PM
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On 10/14/22, Licensing Program Analyst (LPA) Melissa Guirit conducted a Prelicensing inspection today, for the new initial application for preschool. LPA met with Area Manager, Birdie Winrow and toured all areas of the facility for a health and safety inspection. Present for today's inspection were 3 preschoolers and 2 staff. The hours of operation are Monday through Friday from 7:00am to 6:00pm. The measurements from the previous ownership remains the same.

A fire clearance, with a total capacity of 52 preschoolers, ages 2 years to first grade entry and was received from the Contra Costa County Fire Protection Department on 9/30/22.

LPA observed that the classrooms has sufficient lighting and appears to be clean and in good condition. LPA observed an ample supply of age appropriate activities, equipment and furniture. The preschool component operates in 3 classrooms. The facility has a total of 4 sinks and 4 toilets. The building has fully charged 3A40BC fire extinguishers, working fire alarm and carbon monoxide detector, and first aid supplies. There is a working telephone at the center. LPA did not observe any hazardous items that would be accessible to children. Facility will provide water for children, with water still accessible to children inside and outside. Facility will provide breakfast, lunch, and afternoon snack. Facility will utilize electronic sign in/out.

LPA observed the outdoor play area, which is fully fenced. LPA observed one play structure which can be utilized by preschool children. There is sufficient cushion to absorb a child's fall under the play areas. LPA observed ample amount of shade for children.

See 809-C for continuance.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY - BELSHAW ELC
FACILITY NUMBER: 073408945
VISIT DATE: 10/14/2022
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The isolation area will be in the staff office.

Imelda Moreno is considered a qualified Director with current CPR/First Aid and mandated reporter training's completed.

If this facility plans to provide Incidental Medical Services – IMS. 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. LPAs reviewed responses and provided technical assistance including postings. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A preschool license for a capacity of 52 preschool children will be granted today, 10/14/22. There are no deficiencies being cited today. Exit interview conducted with Area Manager, Birdie Winrow.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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