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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806511
Report Date: 10/23/2020
Date Signed: 10/23/2020 01:05:58 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:SOUTH BAY FAMILY YMCA - DISCOVERY ELEMENTARYFACILITY NUMBER:
370806511
ADMINISTRATOR:BREANNA CASTROFACILITY TYPE:
840
ADDRESS:1100 CAMINO BISCAYTELEPHONE:
(619) 656-0797
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:60CENSUS: 21DATE:
10/23/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Gillian GorelikTIME COMPLETED:
01:15 PM
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On 10/22/20 at 12:25pm, Licensing Program Analyst (LPA), Martha Malane arrived at the facility to conduct a case management inspection for the purpose of an increase of capacity. LPA met with the Program Director Gillian Gorelik and Site Supervisor Breanna Castro. There were 21 children and 4 staff members. This School Age Program currently operates at Discovery Elementary School in the following rooms: The Auditorium and #305 with the capacity of 60 and is requesting a capacity increase of 98 in additional new room #302 (the Library will not be utilized). Hours of operation are Monday - Friday from 7:00am to 4:30pm.

Rooms were inspected and are equipped with appropriate furniture, including tables, chairs, and other materials for children. Boys/Girls restrooms are available and located on the south/west side of the auditorium. Restrooms are safe and clean and are sufficient to accommodate the new requested capacity of 98 children. Breanna stated a school staff custodian cleans the bathrooms every 3 hours. A staff restroom is located on the south/west side of the auditorium. Drinking water is available in classrooms via water dispensers and children bring refillable water bottles from home and disposable cups are available if needed.

The isolation area for ill children is located in the auditorium. LPA discussed disinfectants are to be kept inaccessible. Required documents are posted. There is an operational carbon monoxide detector located in room #305 and a first aid kit with required supplies. A grass play area, black top and lunch area with tables and a canopy for shade is located on the east side of the auditorium. Drinking water is available outside via water dispensers and children bring refillable water bottles from home and disposable cups are available if needed.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SOUTH BAY FAMILY YMCA - DISCOVERY ELEMENTARY
FACILITY NUMBER: 370806511
VISIT DATE: 10/23/2020
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A fire clearance for 98 school age children (ages kindergarten – 12 years) was granted on 10/7/20.

No deficiencies issued during today’s inspection. LPA discussed and provided: LIC809, LIC809C, Notice of Site Visit and Appeal Rights. An exit interview was conducted.

An increase of capacity for 98 school age children (ages kindergarten – 12 years) may be granted upon final review
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
LIC809 (FAS) - (06/04)
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