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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200607
Report Date: 06/07/2023
Date Signed: 06/07/2023 02:26:19 PM

Document Has Been Signed on 06/07/2023 02:26 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BERKELEY YMCA HEAD START - SOUTH YMCAFACILITY NUMBER:
010200607
ADMINISTRATOR:DORIAN BURNLEYFACILITY TYPE:
850
ADDRESS:2901 CALIFORNIA STREETTELEPHONE:
(510) 848-9092
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 23DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Dorian Burnley- DirectorTIME COMPLETED:
02:35 PM
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On 6/7/23, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced random annual site inspection. LPA met with and toured all areas utilized by children in care with facility Director Dorian Burnley. There were 23 preschool age children along with 7 teaching staff. The Preschool age children in care utilize rooms 3/4, AND room 6 MONDAY- FRIDAY 7:30AM-5:00PM. There is an infant component associated with the facility who utilize rooms 1, 2 AND 5 (#013420965). Director is aware at no time shall children in care from the 2 components comingle. The facility offers a full day program. The facility is within ratio and capacity. All staff present are background cleared and associated to this facility. Surfaces and counter tops are kept clean and free of toxins or hazardous items. Cleaning supplies/hazardous items are stored inaccessible to children in care during today's inspection. Toilets and faucets are in working condition during today's inspection. This facility serves breakfast, lunch, and snack and menus are posted and available for review. Food storage and preparation areas were inspected and are clean and free of pests. The facility has multiple smoke detectors, fully charged fire extinguishers and a carbon monoxide detector. Floors are clean and free of broken pieces/trip hazards during today's inspection. First Aid supplies were inventoried. The outdoor area is fully enclosed and there is cushioning material under/around all climbing equipment. There are no pools or other accessible bodies or water present during today's inspection. All required postings are present. Sign in and sign out(electronic) is current and accurate. Staff certification in CPR and First Aid is current. Per director, there are no firearms stored in the child care center. The Director stated she takes measures to keep the facility free of flies, rodents, and pest. All staff have provided proof of immunization against pertussis and measles, and provided a note declining the influenza immunization. All staff have completed the mandated reporter training. The last disaster drill was conducted on 5/31/23.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care 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 See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BERKELEY YMCA HEAD START - SOUTH YMCA
FACILITY NUMBER: 010200607
VISIT DATE: 06/07/2023
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California Law requires Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

Director was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Director is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov


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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with Director Dorian Burnley.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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