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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409598
Report Date: 07/22/2024
Date Signed: 07/22/2024 03:24:23 PM

Document Has Been Signed on 07/22/2024 03:24 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA OF THE EAST BAY -LONE TREE ELCFACILITY NUMBER:
073409598
ADMINISTRATOR/
DIRECTOR:		SHAMAICA WALKERFACILITY TYPE:
860
ADDRESS:1931 MOKELUMNE DRIVETELEPHONE:
(925) 450-6954
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 16DATE:
07/22/2024
TYPE OF VISIT:Incorrect data type for operator or @Function: Time/Date expectedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Carla CooperTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Director of Operations Carla Cooper for the purpose of a pre-licensing inspection. Licensee is requesting to add a toddler component for 16 toddlers ages 18-36 months and a decrease in capacity for the currently licensed preschool component for 30 children from age two years to entry into kindergarten for a total capacity of 46. The program currently operates Monday through Friday from 7:00 a.m. to 5:30 p.m. The fire clearance was granted and received on 5/13/2024. The facility currently provides breakfast, lunch, and afternoon snack.

LPA informed Director that the facility will be converted to a single child care center license under facility number 073409598, therefore LPA will be closing the current preschool facility number 073408944.

LPA reviewed with Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with the Regional 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.

INDOOR ACTIVITY SPACE:
There is one toddler classroom located in classroom #1A and two preschool classrooms located in classroom #1B and classroom #2. LPA observed a sufficient amount of equipment, toys, tables, chairs, and cubbies for all classrooms. LPA observed napping cots for the toddlers and preschool children. There is a first aid kit in each of the classrooms.

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY -LONE TREE ELC
FACILITY NUMBER: 073409598
VISIT DATE: 07/22/2024
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Medications will be stored in the office in a locked box. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. LPA observed water pitchers in each classroom. LPA observed a functional carbon monoxide detector in all classrooms. LPA observed an electronic sign-in/sign-out system.

LPA measured the toddler classroom #1A. The toddler classroom contains a total of 301 square feet which will only accommodate 8 toddlers. LPA measured the preschool classrooms #1B and #2. The preschool classroom spaces contain a total of 1,310 square feet which will accommodate Licensee’s request for 37 preschool children. Licensee is requesting to change the requested capacity to 8 toddlers and 37 preschool children. There is one sink located in classroom #1A, four toilets and four sinks located in classroom #1B, and two sinks located in classroom #2. There is a private restroom for staff located in classroom #1B. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area in classroom #2 and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. Licensee has requested a Shared Outdoor Space Waiver for the toddler and preschool children to utilize the same outdoor space at different designated times. Director has provided outdoor schedules to show no commingling between the components. The outdoor play area is fenced with a chain link fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There is one play structure which is approved for ages 2-5 years old. Director understands that children under the age of two years old cannot utilize the play structure at any time. There are no bodies of water on the premises. There are shaded areas supplied by trees and a canopy.

LPA measured the outdoor area. The outdoor area contains a total of 3,405 square feet. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department.

Report continues on LIC809-C page 3.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY -LONE TREE ELC
FACILITY NUMBER: 073409598
VISIT DATE: 07/22/2024
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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Director was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

Report continues on LIC809-C page 4.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA OF THE EAST BAY -LONE TREE ELC
FACILITY NUMBER: 073409598
VISIT DATE: 07/22/2024
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To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Director of Operations Carla Cooper.

The following item is required before a license will be issued:
1. Updated Application (LIC200A) reflecting 8 toddlers and 37 preschool = 45 capacity
2. Amended STD850 from Fire Department
3. Shared Outdoor Space Waiver request
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4