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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600762
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:48:36 PM

Document Has Been Signed on 10/09/2024 04:48 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 CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SOUTH BAY FAMILY YMCA - HERITAGEFACILITY NUMBER:
376600762
ADMINISTRATOR/
DIRECTOR:		JENNY RODRIGUEZFACILITY TYPE:
840
ADDRESS:1450 SANTA LUCIA ROADTELEPHONE:
(619) 421-7080
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 38DATE:
10/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Site Supervisor, Isabel RiveraTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 10/9/2024, at 2:15 PM., Licensing Program Analyst (LPA) Shannan Williams, conducted an unannounced Required 3 Year Inspection and met with Site Supervisor, Isabel Rivera. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This AM/PM half day school-age only program which operates on a traditional school year schedule. Days and hours of operation are Monday through Friday. The morning program operates from 6:00 AM to 8:00 AM. and the afternoon program operates from 2:15 PM. to 6:00 PM. Room 201, library and the multipurpose room are used for care purposes. All required notices, forms and license were posted. There were 38 (thirty-eight) children present along with 3 (three) staff (Teachers).

Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is a large grass area in safe condition and is free of hazards.

Toilet and hand washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Facility has a functioning carbon monoxide detector that meets statutory requirements. The last fire/disaster drill was conducted and documented on 09/09/2024. The facility provides snacks. Menus are posted monthly. Food preparation areas are clean and safe. Notation of children’s allergies is accessible. All food is protected against contamination and any contaminated food is discarded immediately.

Site Supervisor stated there are no bodies of water or on the premises and LPA did not observe any bodies of water. Director stated there are no firearms, weapons, or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible to children. No poisons were observed during the inspection.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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 CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SOUTH BAY FAMILY YMCA - HERITAGE
FACILITY NUMBER: 376600762
VISIT DATE: 10/09/2024
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A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

All required notices, forms and license(s) were posted. Capacity and limitations as specified on the license are being maintained. At least one person trained in EMSA approved Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher, designated to act in the director’s absence, has been reported to the Department. Children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full signature and record the time of day. Sign in/out sheets reviewed and observed by the LPA meet this regulation. Facility maintains a ratio of one teacher supervising no more than 14 children in care. This facility does not transport children.


LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication, equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link ttps://www.ada.gov/childqanda.htm.


LPA and director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms and Regulations, Safe Sleep in Childcare, Lead Poisoning Facts, Guardian and California Megan’s Law (www.meganslaw.ca.gov).
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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 CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SOUTH BAY FAMILY YMCA - HERITAGE
FACILITY NUMBER: 376600762
VISIT DATE: 10/09/2024
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Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with Site Supervisor, Isabel Rivera. A copy of this report, along with Appeal Rights (LIC9058), were provided. A Notice of Site Visit was given and must remain posted for 30 days. LPA observed that the Notice of Site Visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Upon review of Facility Evaluation Report and LPA observation of the signed and stamped received by RO June 7, 2024. The Administrator name for CCLD should be Isabel Rivera. LPA will make necessary change to name of Administrator.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC809 (FAS) - (06/04)
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