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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411575
Report Date: 03/05/2026
Date Signed: 03/05/2026 02:43:19 PM

Document Has Been Signed on 03/05/2026 02:43 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA @ OAK ELEMENTARYFACILITY NUMBER:
434411575
ADMINISTRATOR/
DIRECTOR:
ANA LOURDES NANEVICZFACILITY TYPE:
840
ADDRESS:1501 OAK AVENUETELEPHONE:
(650) 969-6865
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 37DATE:
03/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Lourdes NaneviczTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On March 5, 2026, at 12:35 PM, Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Random Inspection and met with Site Director Lourdes Nanevicz. LPA disclosed the purpose of the inspection, and the facility was toured both inside and outside to conduct a health and safety inspection. There were 37 school-age children present during this inspection and four staff members. The center is located on the campus of Oak Elementary School and operates Monday through Friday from 7:00 AM to 6:00 PM for before-school care and from 2:00 PM to 6:00 PM for after-school care.

LPA reviewed facility records and verified that all individuals subject to criminal record review have received a clearance or exemption and are associated with the facility. LPA conducted a census of the children, and the census matched the 37 electronic signatures signed in on the facility’s electronic system. At approximately 1:00 PM, LPA reviewed six (6) children’s files and three (3) staff files. All staff files contained the required Health Screening and Employee Rights forms. All children’s files contained Personal Rights, Medical Consent forms, and Identification and Emergency Information forms. At least one opening and closing staff member has a current CPR and First Aid certification.

The large classroom was inspected at approximately 12:40 PM, and staff-to-child ratios were in compliance with licensing regulations. There are adequate play and learning materials available. The room temperature was adequate for children in care, and the floors were observed to be clean and well maintained. The furniture was appropriately sized for school-age children, and individual storage space was available for each child in care. The designated isolation area for sick children is located next to the director’s desk, away from other children in care.

LPA tested the center’s smoke detector and carbon monoxide detector and found them to be functioning properly. The center has a working telephone, a pull-down fire alarm system, and multiple fully charged 3A40BC fire extinguishers located throughout the center, which meet the standards established by the State Fire Marshal. Disaster drills are conducted at least once every six months, with the last drill conducted on 02/10/2026. All required documents are posted in a publicly accessible area.



See 809-C.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA @ OAK ELEMENTARY
FACILITY NUMBER: 434411575
VISIT DATE: 03/05/2026
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This facility provides snacks for the children, and weekly menus are posted at the facility. LPA observed the area where the refrigerator is located and found the area to be clean and free of evidence of rodents. Food is protected from contamination and, per staff, any contaminated food is discarded immediately. LPA reminded the director that all persons engaged in food preparation and service shall observe proper personal hygiene and food service sanitation practices to protect food from contamination. All storage containers for solid waste have tight-fitting covers and are in good repair.

The center uses the elementary school’s playground for outdoor play. The playground has multiple play structures that are anchored to the ground. The play structures with slides have cushioning underneath to absorb falls. Trees provide shade and protection from harmful sunlight during outdoor play. The children brings their water bottle to the playground for outdoor play. The play equipment is age-appropriate and in good repair..

LPA’s Observation During Inspection:
At approximately 1:30 PM, the children began arriving at the facility and signing into the electronic sign-in system. One staff member was responsible for the sign-in tablet while other staff members assisted the children as they arrived. One group of children sat on the rug during circle time while staff reviewed the day’s activities. Some children sat at multiple tables with homework, books, or activity sheets and began working. Staff were positioned throughout the classroom, and some monitored the bathrooms as children came and went. The children’s voices were calm, and no children were yelling. Staff engaged with the children and answered their questions about the presence of licensing staff at the facility.

LPA inspected the staff bathroom at approximately 1:25 PM and was informed by the representative that it is separate from the children’s bathroom. LPA observed that one of the bathrooms contains a stall marked for staff use only. Per staff, this stall is used only when no children are present in the bathroom. LPA verified that the toilets were operating properly by flushing them to ensure they were in safe working condition. The center has an adequate supply of soap, toilet tissue, and paper towels available for children in care.


California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The director was also reminded 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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: https://www.ada.gov/resources/child-care-centers/



See 809-C.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: YMCA @ OAK ELEMENTARY
FACILITY NUMBER: 434411575
VISIT DATE: 03/05/2026
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Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The director was reminded that all adults 18 and over, 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.

The director was informed of the MyChildCarePlan.org website; 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.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site director Lourdes Nanevicz

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Elimika Woods
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4