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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417825
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:28:27 PM

Document Has Been Signed on 04/10/2023 02:28 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BERKELEY YMCA EHS - VERA CASEYFACILITY NUMBER:
013417825
ADMINISTRATOR:GLORIA CROSS-BROOKSFACILITY TYPE:
830
ADDRESS:2246 MARTIN LUTHER KING JR WAYTELEPHONE:
(510) 542-2146
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 26TOTAL ENROLLED CHILDREN: 18CENSUS: 18DATE:
04/10/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Kathy NugyenTIME COMPLETED:
02:35 PM
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On April 10, 2023 at 1:05pm, Licensing Program Analyst (LPA) Indira Loza met with Assistant Director Kathy Nugyen for an Unannounced Required Annual Inspection. There were 18 infants in care and six staff members. The teacher- child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from Monday through Friday from 7:30am–5:00pm.

The center operates out of a building with three classrooms. The room floors, surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The heating, lighting and ventilation is adequate. There is a separate bathroom for staff located on the third floor of the building. The activities and toys appear to be age appropriate. There are sleeping mats and blankets for the older infants, and individual cribs for the younger infants. The outside play area is fully fenced in with shaded areas and age appropriate toys. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to infants during todays inspection. The center provides breakfast, lunch, and one afternoon snack. Food is provided from an outside vendor and the school provides for those infants who don't eat table food. Drinking water is available inside and outside the center. The center has a working carbon monoxide detector and smoke detector and fully charged 2A10BC fire extinguishers.



There are separate bathrooms for the children and staff. Toilets and faucets work properly. The children are able to reach the sink and toilets. Toilet paper, soap, and paper towels are all available to the children. There is a changing table for the infants in care that is within arms reach of the sink. This facility is currently providing IMS services to children. LPA reviewed the medications and required documents. All the documents were being maintained and the medications were all within the expiration date. The facility is operating within its licensed capacity and is in ratio today. All proper postings are made visible by the entrance area of the center. The fire/disaster drill log was complete with the last drill logged March 30, 2023. The center's sign-in and out log is complete. LPA obtained and reviewed six infant’s files and six staff files. *************************************Report Continues on 809-C***************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BERKELEY YMCA EHS - VERA CASEY
FACILITY NUMBER: 013417825
VISIT DATE: 04/10/2023
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All files were complete. There is an opening and closing staff with current CPR certifications. The isolation are is located on the third floor.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be maintained. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed 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.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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. Director 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.

LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

*************************************Report Continues on 809-C***************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BERKELEY YMCA EHS - VERA CASEY
FACILITY NUMBER: 013417825
VISIT DATE: 04/10/2023
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 No deficiencies were observed during today's inspection.

A notice of site visit was given and must remain posted for 30 days
Exit interview conducted
Report and Appeal Right provided to Area Manager Joshua Jackson.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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