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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213011
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:27:19 PM

Document Has Been Signed on 12/01/2023 03:27 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
OAKLAND SOUTH EAST, 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: 26CENSUS: 24DATE:
12/01/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rose Kekaula-AkotueTIME COMPLETED:
03:45 PM
NARRATIVE
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On 12/01/2023 at 11:30am, Licensing Program Analyst (LPA) Christina Uribe conducted an Unannounced Annual Required Inspection. LPA met with site director, Rose Kekaula-Akotue, also present at the time of the inspection were 2 staff & 24 children. The facility is within ratio & capacity compliance today. LPA provided facility representative the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety inspection. The facility currently operates 7:00am-6:00pm, Monday-Friday in one classroom. The facility is located on the Castro Valley Elementary School Campus.

Classrooms: The classroom was inspected for age-appropriate furnishings, equipment, & adequate storage for children’s belongings. LPA observed the cleanliness of floors & surfaces, the presence of a fully functional carbon monoxide detector, smoke detector/fire alarms, and a fully charged 3A40BC fire extinguisher that is accessible throughout the facility. The center is equipped with a fully stocked first-aid kit and available in the classroom.

Food Service Areas: All center provided food items are properly labeled & stored separately from cleaning supplies. Food prep area is clean, adequately equipped, & free from hazardous materials. Snack menu is posted one week in advance, available for review, & dated. Solid waste bins are equipped with tight fitting lid.

Bathrooms: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe and sanitary operating condition. The children are able to reach the sinks, toilets, and supplies.

Outdoor Play Area: The playground outside is fenced and all equipment and surfaces are free from hazards. There are no bodies of water, or free-standing water accessible to children. There are age appropriate toys and materials for the children. Facility utilizes the school playground on campus.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/01/2023 03:27 PM - It Cannot Be Edited


Created By: Christina Uribe On 12/01/2023 at 01:40 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)(2)
Section 101170 - Criminal Record Clearance: (e) All individuals subject to a criminal record review shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as all staff members present during toda's inspection have a criminal record clearance but are not associated to the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will take the necessary steps to transfer all staff members to the facility roster on the Guardian website and will complete this directive before the due date of 12/15/23. LPA Uribe will verify that the transfers have been completed by accessing the Guardian website after the due date.
Type B
Section Cited
CCR
101212(b)
Section 101212 - Reporting Requirements: (b) The name of the child care center director shall be reported to the Department within 10 days of a change of child care center director or disignee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview & record review, the licensee did not comply with the section cited above as upon arrival at the facility for today's inspection, LPA Uribe was informed that the previous director is no longer employed at the facility and a new director was appointed in October 2023. CCLD was not notified of this change within the required time frame. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will obtain a copy of all the required documents for a director packet to be reviewed no later than the due date of 12/15/23. LPA provided a copy of the required documents for a director packet during today's visit. LPA Uribe will return to the facility to verify that the plan of correction has been met. Failure to comply with this plan of correction and due date will result in the issuance of an additional violation.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


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Document Has Been Signed on 12/01/2023 03:27 PM - It Cannot Be Edited


Created By: Christina Uribe On 12/01/2023 at 01:52 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as one child had two prescription medications which were stored without the original packaging and/or the prescription label which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will return these medications to the child's authorized representatives and obtain new medications which shall include the original packaging and the prescription label no later than the due date of 12/15/23. LPA Uribe will return to the facility to verify that the plan of correction has been met. Failure to comply with this plan of correction and due date will result in the issuance of an additional violation.
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as there are either missing or incomplete Parent Consent for Administration of Medicaiton (LIC 9221) forms for children's medications which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will ensure that the children's authorized representative accurately and completely fills out the Parent Consent for Administration of Medication (LIC 9221) forms for each medication no later than the due date of 12/15/23. LPA Uribe will return to the facility to verify that the plan of correction has been met. Failure to comply with this plan of correction and due date will result in the issuance of an additional violation.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011
VISIT DATE: 12/01/2023
NARRATIVE
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Records: LPA reviewed 5 children’s files and 3 staff files. LPA reviewed the facility roster & personnel report and copies were obtained. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Mandated Reporter certificates were reviewed. Director was reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The center is in compliance with sign in and out procedure. Emergency Drills are recorded and performed at least every six months. Per facility representative, there are no firearms on the premises. All required documents are posted in a publicly accessible area.

Criminal Record Clearance: Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing: 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. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA inspected storage of medications and equipment/supplies, and reviewed children’s, personnel, and administrative records. All children’s medications are securely stored. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEY
FACILITY NUMBER: 010213011
VISIT DATE: 12/01/2023
NARRATIVE
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MyChildCarePlan.org: Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care Licensees 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 to the regional office by phone and the written report, LIC 624, within 7 business days.

See list below and attached pages for deficiencies and advisory notes issued today:

  • Type B Violation: All staff members present during today's visit are not associated to the facility. They all do have an active criminal record clearance but these need to be transferred to the facility.
  • Type B Violation: The licensee did not follow the reporting requirements to notify CCLD within 10 days of a change in center director. A change in center director took place in October 2023.
  • Type B Violation: One child has two medications that do not have the original packaging and/or the prescription label.
  • Type B Violation: Two children's records either have incomplete or missing Parent Consent for Administration of Medication (LIC 9221) forms to accompany their medications stored at the facility.
  • Technical Violation: Two staff members have certifications for the incorrect CPR/First Aid course.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were given and reviewed. Exit interview conducted and report was reviewed with the director, Rose Kekaula-Akotue.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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