<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212378
Report Date: 01/31/2022
Date Signed: 01/31/2022 03:32:45 PM

Document Has Been Signed on 01/31/2022 03:32 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:YMCA OF THE EAST BAY - RODEO CDCFACILITY NUMBER:
070212378
ADMINISTRATOR:PAMELA WILLIAMSFACILITY TYPE:
850
ADDRESS:200 LAKE AVENUETELEPHONE:
(510) 412-5644
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY: 64TOTAL ENROLLED CHILDREN: 38CENSUS: 18DATE:
01/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Shannon DillionTIME COMPLETED:
03:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/31/22 at 2:00 PM Licensing Program Analysts (LPAs) Michelle Sutton and Monica Mathur conducted an unannounced Case Management inspection about an unusual incident self reported by the Center. A parent reported to Center that her child was hit by a staff. LPAs met with Director Shannon Dillion and explained the purpose of today's inspection.

LPAs conducted interviews with staff and received copies of Children's Roster and Personnel Report. During the inspection there were no deficiencies cited.

At 3:30PM an exit interview was conducted with Shannon Dillion the report was discussed and signed. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1