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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600781
Report Date: 11/14/2019
Date Signed: 11/14/2019 04:32:15 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 YMCA - MC MILLIN ELEMENTARYFACILITY NUMBER:
376600781
ADMINISTRATOR:JESUS GOMEZFACILITY TYPE:
840
ADDRESS:1201 SANTA CORA AVENUETELEPHONE:
(619) 397-0103
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:60CENSUS: 35DATE:
11/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jesus Emilio GomezTIME COMPLETED:
04:30 PM
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(1)LPA Armando Locano completed an un-announced annual site inspection today. The purpose of the visit is to ensure the facility is maintaining the health and safety standards as required by Community Care Licensing (CCL) Regulations governing Child Care Centers. Met with Site Supervisor Jesus Emilio Gomez, 35 children were present during the visit, with 2 teachers and one aide present. Classroom and playgrounds were toured and children were observed to be within proper teacher child capacity ratios, being properly supervised.

LPA toured the facility, reviewed sign in and out sheets, menus, rest room areas, classrooms and equipment to ensure compliance with CCL Regulations. Facility roster was verified to be up to date and it was verified facility conducts fire and earthquake drills at least twice a year, most recent earthquake and fire drills were conducted in 11/8/19. Per tour of the classroom, LPA observed a variety of age-appropriate, materials and equipment available for children’s use. Storage areas were verified to be properly locked and inaccessible, waste baskets were properly covered and drinking water was available for children in classrooms and outdoor play areas. Outside playground areas were toured and verified to be properly fenced, with proper age appropriate equipment for children’s use and proper shade available for children. Staff and children’s records were reviewed and verified proper forms were in order. There were operational Type II 10ABC fire extinguishers and working smoke and carbon monoxide alarms in the facility, CPR, First Aid and Mandated Reporter certificates were verified to be up to date. A review of staff records today November 14, 2019, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Continued on next page….
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Armando LocanoTELEPHONE: (619) 767-2221
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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 YMCA - MC MILLIN ELEMENTARY
FACILITY NUMBER: 376600781
VISIT DATE: 11/14/2019
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Continued from previous page…

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department, an IMS plan has been submitted and approved and in file for this facility. 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 Director discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed new LEAD information regarding effects of lead exposure and current LEAD handout during visit.

Per new Senate Bill 792 pertaining to immunizations, which require all adults in daycare operation to have proof of immunizations for; Measles, Pertussis and Influenza, verification of required immunizations was in staff files and facility is in full compliance.

There are no deficiencies cited on this visit, all documentation was in order, properly posted and the facility was found to be properly childproofed.

LPA provided copy of LIC 9213, “Notice of Site Visit,” and observed posting of notice during visit.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Armando LocanoTELEPHONE: (619) 767-2221
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC809 (FAS) - (06/04)
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