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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005393
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:09:53 PM


Document Has Been Signed on 12/13/2023 04:09 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:TOBY WELLS YMCA - HOLMES ELEMFACILITY NUMBER:
372005393
ADMINISTRATOR:FLENT ADLEANFACILITY TYPE:
840
ADDRESS:4902 MOUNT ARARAT DRIVETELEPHONE:
(858) 496-8110
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:125CENSUS: 63DATE:
12/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Kevin Starling/Program Director and Jaelin Ford/Site SupervisorTIME COMPLETED:
04:20 PM
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On 12/13/2023 at 12:40PM, Licensing Program Analysts (LPAs) Selina Siao and Gerald Poindexter conducted an unannounced inspection. Upon arrival, LPAs met with Program Director Kevin Starling and Site Supervisor Jaelin Ford who were at room #1 supervising 26 children that are in first and second grade. The group proceeded to the red structure playground to combine with 37 children who are in the green and purple group supervised by teachers Audrey Baldonado, Merik Albert Wilson, and Carolina Levine. During the inspection staff Lauren Deleon, Amanda Yanger and Wessly Danzy arrived at the facility's playground to supervise the children. LPAs conducted an inspection of both of the licensed rooms #1 and #18. LPAs observed some hazardous items under the sink cabinet in room #1 including disinfectant cleaner, Windex window cleaner and air freshener. All required notices, forms and license were posted in room #18. Furniture and age-appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation and drinking water from the classroom faucets. The children puts their backpack outside both of the classrooms. The children uses multiple restrooms throughout the campus. The bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. The snack menu is posted. Adequate food is available for snacks that are located in a locked cabinet in room #18 and there is a refrigerator in the auditorium that the program uses to store other snacks. Program Director Kevin Starling stated that the children uses the outdoor play area throughout the campus but most of the time they use the red playground structure located by room #18. Climbing structures and slides are securely fixed to the ground. Area has the building used for shade. Area has an operational drinking fountain and grounds are free of debris or potential hazards. LPA reviewed first aid supplies and reviewed medication policy and storage, all areas are within compliance. Isolation areas includes classroom #18, #1 or outside and the child who is ill will be kept away from the rest of the children. Personnel and client records were reviewed, and staff members have the required immunization and have completed the online mandated reporter training. Reporting requirements was also reviewed.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TOBY WELLS YMCA - HOLMES ELEM
FACILITY NUMBER: 372005393
VISIT DATE: 12/13/2023
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 All personnel have the required criminal record and child abuse index clearances or exemptions. LPA reviewed Emergency Disaster Plan and the last fire drill was conducted on 11/07/2023. Facility has an operating carbon monoxide detector located in room #18 by the sink area. Facility has multiple staff members with a valid EMSA approved pediatric CPR/FA when children are in care.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe. LPA discussed California Megan's Law with provider and advised her to go on the website at www.meganslaw.ca.gov.

Facility 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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TOBY WELLS YMCA - HOLMES ELEM
FACILITY NUMBER: 372005393
VISIT DATE: 12/13/2023
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LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov .

Please refer to the LIC 809D for citations.

Exit interview conducted and report was reviewed with the facility representative Kevin Starling.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/13/2023 04:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: TOBY WELLS YMCA - HOLMES ELEM
FACILITY NUMBER: 372005393

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as there were some hazardous items including disinfectant cleaner, air freshener and windex under the sink cabinet that are accessible to children located in room #1. Which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2023
Plan of Correction
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Facility representative will have a meeting with all the staff members to inform them that all items with labels "keep out of reach of children" shall be inaccessible to children. The meeting agenda and staff members sign in sheet shall be submit to licensing no later than 12/18/2023.
Type B
Section Cited
CCR
101229(a)(1)
Responsibility For Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as a day care child went into room #18 without visual supervision of a staff. LPA brought the child to the playground during the inspection. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2023
Plan of Correction
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Program Director stated that he will meet with the staff members regarding the importance of visual supervision. Program Director will remind the children to inform a staff when he/she needs to get something in the classroom or use the restroom.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
LIC809 (FAS) - (06/04)
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