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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212378
Report Date: 10/26/2023
Date Signed: 10/26/2023 11:37:07 AM

Document Has Been Signed on 10/26/2023 11:37 AM - 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:SHANNON DILLONFACILITY TYPE:
850
ADDRESS:200 LAKE AVENUETELEPHONE:
(510) 412-5644
CITY:RODEOSTATE: CAZIP CODE:
94572
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 42DATE:
10/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:WALKER, JODY TIME COMPLETED:
12:00 PM
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On October 26, at 9:30 AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced Unusual/incident report follow up from incident reported on October 14, 2023. LPA met with Area Manager Jody Walker advising the nature of the visit. Present during the investigation were (8) staff members, (42) children consisting of (12) toddler,(30) preschool children. LPA conducted interviews with staff and child regarding the incident in question. LPA obtained a copy of the current roster and statements from staff.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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