Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600553
Report Date: 10/25/2017
Date Signed 10/25/2017 03:28:45 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: 30DATE:
10/25/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Luisa PenaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Iman Al-Absi conducted an unannounced Annual Random site inspection on this date. Upon arrival, LPA met with Site Supervisor Luisa Pena and proceeded to tour the facility. All required notices, forms and license were posted. There were no children in care upon arrival but 30 children arrived during inspection and were present with three staff.

Furniture and age appropriate equipment is in good condition. Floors are clean and safe. Backpack storage is readily available and room accommodates class size. The fire extinguisher and carbon monoxide detector meet requirements and are operational Bathrooms are safe and sanitary, maintained with operational toilets and faucets with appropriate temperature. Air dryer and toilet paper are available. Bathroom is lighted and has ventilation. Trash cans have tight fitting covers in good repair. Children are provided drinking water from an operational water fountain both inside and outside the classroom. Adequate food is available for snacks. Medication is stored in a locked cabinet inaccessible to children. There is at least one staff present with a current CPR and First Aid certification. Outdoor play area is a fenced. Facility only uses black top for outdoor activities. Area has trees used for shade. Last fire drill was conducted on October 13, 2017.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS Information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: http://www.ada.gov/childqanda.htm

LPA reviewed sign in sheets. Personnel records were reviewed for immunizations per SB 792. Client records were reviewed for LIC 700 (Identification and Emergency Information) and Medical Assessment. All personnel have required criminal record and child abuse index clearances or exemptions. An exit interview was conducted. No deficiencies were observed or cited during today's visit.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2017
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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