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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213011
Report Date: 10/22/2021
Date Signed: 10/22/2021 04:54:22 PM

Document Has Been Signed on 10/22/2021 04:54 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEYFACILITY NUMBER:
010213011
ADMINISTRATOR:WILLIAMS, LATASHIAFACILITY TYPE:
840
ADDRESS:20185 SAN MIGUEL AVENUETELEPHONE:
(510) 881-4458
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 19DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Astra BirznieksTIME COMPLETED:
05:04 PM
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On 10/22/2021 at 1:20pm, Licensing Program Analysts (LPAs) Jonathan Williams and Kelly Phan met with Astra Birznieks for an unannounced Required 1-Year Inspection. Present for this inspection are two fingerprint cleared and associated staff members (one fully qualified teacher and one teacher aide) and 19 school-aged children in care. Facility operating hours are 7am-6pm M-F. The facility was toured to conduct a health and safety inspection.

At 1:20pm, LPAs toured the facility classroom. The facility operates in a portable on the site of Castro Valley Elementary School. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classrooms. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Snack food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children inside and outside the facility.

At 1:29pm, LPAs toured the facility bathroom. LPAs observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.

At 1:32pm, LPAs toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls. Uncontaminated drinking water is available to children in the outdoor area. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011
VISIT DATE: 10/22/2021
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At 1:37pm, LPAs reviewed sign in/sign out sheet. LPAs observed 19 signatures out of 19 children present in the facility during today's inspection.

The facility has two fully charged 3A40BC fire extinguishers, working smoke detector, working carbon monoxide detector, and working telephone. At least one staff member has current CPR/1st Aid certificate. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing 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.”

Facility Representative 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 Child Care 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.

Facility Representative was reminded that California Law requires licensed 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011
VISIT DATE: 10/22/2021
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There are no deficiencies cited. 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. Appeal rights were provided to the Facility Representative and the signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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