Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600553
Report Date: 07/13/2016
Date Signed 07/13/2016 01:08:42 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:LUISA PENAFACILITY TYPE:
840
ADDRESS:2295 MACKENZIE CREEKTELEPHONE:
(619) 870-6422
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY:60CENSUS: 0DATE:
07/13/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:TIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Iman Kayyali a Case Management visit on this date. Upon arrival, LPA met with Program Director Karina Pina-Armas. The purpose of today's meeting is to measure and approve room 704 for use.

Fire clearance has been approved and received by Licensing. Classroom 704 measure for a capacity of 24 children. Furniture and ago appropriate equipment is in good condition. Room has adequate heating, lighting, ventilation. Facility will use multipurpose room and room 704 for the care of children.

The facility is in substantial compliance with CCR, Title 22, Division 12, Chapter 1 regulations. Room 704 is approved for use effective today.
SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2016
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 1