376600186-12-18-2019-20-CC-VWIN-BJZ35S-20191218165709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600186
Report Date: 12/18/2019
Date Signed: 12/18/2019 04:57:16 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-OLYMPICVIEW ELEMENTARY		FACILITY NUMBER:	376600186
ADMINISTRATOR:	MIRIAM MARTINEZ		FACILITY TYPE:	840
ADDRESS:	1220 SOUTH GREENSVIEW DRIVE		TELEPHONE:	(619) 656-2030
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91915
CAPACITY:	60	CENSUS: 21	DATE:	12/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Breanna Castro		TIME COMPLETED:	05:05 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 Analyst (LPA) Vicky Williamson conducted an annual random inspection. LPA met with Assistant Site Supervisor, Breanna Castro and inspected inspected the facility. The playground, classrooms and children's restrooms were inspected. There were 21 school age children present with 3 teachers. Students were observed participating in various indoor activities. The program operates Monday - Thursday 2:30 PM - 6:30 PM and on Friday from 1:00 PM to 6:30 PM. Classrooms have lighting, heating, and ventilation as well as an operational carbon monoxide detector. Children are being escorted to and from the restrooms with visual observation. All floors appeared to be clean and safe. Furniture including tables, chairs and equipment appeared to be in good condition. Trash cans containing discarded food have tight-fitting covers. Facility appears to be free of flies, other insects and rodents. Disinfectants, cleaning solutions and other hazardous items were locked and inaccessible to children. Snack menu is posted monthly. The surface of the outdoor activity space is maintained in a safe condition and free of hazards. Drinking water is available inside and outside of the classrooms. Sign out sheets were reviewed showing staff and parent/guardian’s signature and time of day recorded. Site Supervisor states there are no firearms or weapons on the premises. The last disaster drill was conducted and documented on 12/6/19. Children records, including medical assessment and facility roster were all reviewed. Staff records, including health screening, immunization record and transcripts were reviewed to verify teacher qualifications and experience. Opening and closing staff members have current CPR and First Aid certifications. All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions and are associated to the Administrative site (376600644). Mandated Reporter 1207 certification and immunization records are in compliance for staff members present.

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

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-OLYMPICVIEW ELEMENTARY	FACILITY NUMBER: 376600186
	VISIT DATE: 12/18/2019

NARRATIVE

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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 and Site Supervisor reviewed reporting requirements, medication storage and supervision. Director was provided information on the following: Lead Exposure and Provider Information Notice (PINS) - PIN 19-09-CP and 19-08-CCP.

Please submit updated forms LIC 610 and LIC 500 to the Licensing Agency by January 18, 2020

No deficiencies cited during today's inspection. Facility was provided a copy of the appeal rights form LIC 9058 and the signature on this form acknowledges receipt of these rights.

The Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted.

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Vicky Williamson	TELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

LIC809 (FAS) - (06/04)

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