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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600552
Report Date: 01/26/2023
Date Signed: 01/26/2023 06:27:32 PM


Document Has Been Signed on 01/26/2023 06:27 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:MISSION VALLEY YMCA - BAY PARK ELEMENTARY SCH. AGEFACILITY NUMBER:
376600552
ADMINISTRATOR:MELANIE WAYMIREFACILITY TYPE:
840
ADDRESS:2433 DENVER STREETTELEPHONE:
(619) 298-3576
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:125CENSUS: 59DATE:
01/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Dayna WhittyTIME COMPLETED:
03:30 PM
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On 1/26/23 LPA Patrick Ma made an unannounced Case Management visit to investigate unusual incident report reported on 12/19/22. Upon arrival, LPA met with Site Supervisor Dayna Whitty. Also present at the facility were 59 daycare children with 6 staff. Facility is within ratio and capacity.

LPA Ma reviewed the incident with the Site Supervisor, toured the playground where the incident happened, interviewed staff, reviewed relevant files and provided Site Supervisor Title 22 Section 101238 Buildings and Grounds regulations. Playground equipment and outdoor surfaces meet regulations, however, concrete area with picnic tables had cushioning debris scattered around.

LPA verified proper fist aide was applied and parent was called. The child recovered and returned to the center and continues to attend, to date. Per complete review of all information, staff took appropriate steps in aiding the child and contacting the parents and it has been determined the incident was an accident. As such, facility took appropriate actions and no violations are issued to the facility regarding this issue.

Exit interview conducted and report was reviewed with the facility representative Dayna Whitty. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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