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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600051
Report Date: 10/23/2020
Date Signed: 10/24/2020 12:58:56 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-CHULA VISTA HILLS ELEMENTARYFACILITY NUMBER:
376600051
ADMINISTRATOR:BLANCA RINCONFACILITY TYPE:
840
ADDRESS:980 BUENA VISTA WAYTELEPHONE:
6194827066
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:60CENSUS: 32DATE:
10/23/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Gillian GorelikTIME COMPLETED:
12:15 PM
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On 10/22/20 at 11:20am, 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 Program Director Gillian Gorelik and Site Supervisor Blanca Rincon. There were 32 children and 4 staff members. This School Age Program currently operates at Chula Vista Elementary School in the following rooms: The Auditorium and #705 with the capacity of 60 and is requesting a capacity increase of 70 in additional new room #305. 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 north side of the auditorium. Restrooms are safe and clean and sufficient to accommodate the new requested capacity of 70 children. Staff stated a school staff custodian cleans the bathrooms every 3 hours. A staff restroom is located on the east 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 on the stage the auditorium. LPA discussed disinfectants are to be kept inaccessible. Required documents are posted. There is an operational carbon monoxide detector located in the Y Room and a first aid kit with required supplies. A grass play area, black top and lunch area with tables and trees for shade are located on the west side 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-CHULA VISTA HILLS ELEMENTARY
FACILITY NUMBER: 376600051
VISIT DATE: 10/23/2020
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A fire clearance for 70 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 70 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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