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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409600
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:09:25 PM

Document Has Been Signed on 11/15/2024 03:09 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 - EAST TREGALLAS ELCFACILITY NUMBER:
073409600
ADMINISTRATOR/
DIRECTOR:		BIRDIE WINROWFACILITY TYPE:
860
ADDRESS:112 EAST TREGALLAS ROADTELEPHONE:
(510) 809-2261
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 102TOTAL ENROLLED CHILDREN: 59CENSUS: 44DATE:
11/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Shamaica WalkerTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On 11/15/2024 at 12:00 PM, Licensing Program Analyst(s) (LPAs) Christina Watts and Kareeca "Recca" Sykes conducted a Case Management Inspectionvat YMCA of the East Bay - East Tregallas. LPAs meet with Director, Shamaica Walker and explained the purpose of today's inspection. During today's inspection, there 44 children in care (6 infants, 11 toddlers, 27 preschool children) with 14 staff in in 4 classrooms. Director stated 59 children are enrolled. All staff caring and supervising children have Criminal Record Clearance.

LPA's are following up on an self reported Unusual Incident Report. On 11/05/2024, S1 gave C1 an known allergy. Interviews stated that at lunch time, S1 served C1 and the other children cows milk. S1 stated that S2 or S3 told S1 that C1 is allergic to cows milk. S1 stated they were not previously aware that C1 was allergic to cows milk. Multiple Interviews stated S1 was aware of C1's allergy and was moving too fast. S1 stated that either S2 or S3 called C1's parent/authorized representative to pick up C1. C1 went to the Emergency room to receive medical care. Interviews and facility observation shows that there is an allergy list in every classroom. Multiple interviews also stated that a similar incident did occur where C1 drank an known allergen about a month ago. Per California Code of Regulations, Title 22, facility cannot serve a child any known food allergies, particularly a life threatening allergy. This facility is out of compliance with California Code of Regulations, Title 22.

LPA Christina Watts informed Director Shamacia Walker that this report dated 11/15/24 with 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Furthermore, LPA Watts informed the Director Shamaica Walker to provide a copy of this licensing report dated 11/15/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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Document Has Been Signed on 11/15/2024 03:09 PM - It Cannot Be Edited


Created By: Christina Watts On 11/15/2024 at 02:13 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY - EAST TREGALLAS ELC
FACILITY NUMBER: 073409600

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
Section Cited
CCR
101227(a)(7)(B)

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101227 Food Services (a)In child care centers providing meals to children, the following shall apply: (7) Modified diets prescribed by a child's physician as a medical necessity shall be provided. (B) A child shall not be served any food to which the child's record indicates he/she has an allergy.
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On 11/15/2024, Facility has submitted facility training agenda which included personal rights, children's health needs and allergies, meal service and other topics. LPA will clear this deficiency as of 11/15/2024.
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This requirement has not been met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above when C1 was drank known allergy on at least 2 ocassions which poses an immediate risk to the health, safety or personal rights of children in care.
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


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: YMCA OF THE EAST BAY - EAST TREGALLAS ELC
FACILITY NUMBER: 073409600
VISIT DATE: 11/15/2024
NARRATIVE
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*PAGE 2*

*SEE LIC 809-D FOR DEFICIENCIES*

Exit interview conducted and report was reviewed with Director, Shamacia Walker. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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