Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600553
Report Date: 04/17/2015 12:00:00 AM
Date Signed 04/17/2015 03:24:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SO. BAY FAM. YMCA - THURGOOD MARSHALLFACILITY NUMBER:
376600553
ADMINISTRATOR:CASSANDRA CASASFACILITY TYPE:
840
ADDRESS:2295 MACKENZIE CREEKTELEPHONE:
(619) 971-0862
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY:60CENSUS: 13DATE:
04/17/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Wendi Messina and Cassandra CasasTIME COMPLETED:
04:00 PM
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(2) LPA Carl Shelton visited the facility to conduct a Annual Random site inspection. Upon arrival LPA met with Department Head, Wendi Messina, and Site Director, Cassandra Casas, and proceeded to tour the facility. The licensee has applied to use additional classroom #605 to the facility. The additional room with the current auditorium have been granted a current fire clearance. All required notices, forms and license were posted. There were 13 school age children with 2 teachers. Facility is within ratio and capacity. Children were not left without supervision during visit. Site provides before and after care from 6 - 8:45am, 3:00 - 6:30 pm, Fridays/Minimum days are 1:30pm - 6:30pm. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation and drinking water from an operational water fountain at exit door. Floors are clean and safe. Storage cubbies are readily available and room accommodates class size. Facility uses elementary school bathrooms which are safe and sanitary, maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Food service area consists of a refrigerator which is clean and free of hazards. Trash cans have tight fitting covers in good repair. Menu is posted. Adequate food is available for snacks. Cleaning supplies are inaccessible. Children and staff files were reviewed and maintained. Sign in sheets reviewed and maintained. There is at least one staff present with a current CPR and First Aid certification. Outdoor play area is a fenced elementary school blacktop area. Elementary school play structures are not allowed for center use. Area has an operational drinking fountain and grounds are free of debris or potential hazards. All personnel have required criminal record and child abuse index clearances or exemptions. Facility advised to submit an updated copy of LIC 500 and a new parent handbook if there has been changes made to the original. Facility is advised that if site supervisor will be out for an extended period of time a new site supervisor/lead teacher must be designated to act in Site Supervisor's absence within 10 days of change. The additional room #605 is granted for use effective today.

The facility is in substantial compliance with CCR, Title 22, Division 12, Chapter 1 regulations. Discussed appeal rights.
SUPERVISOR'S NAME: Carol AugustTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Carl SheltonTELEPHONE: 619-767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2015
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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