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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700048
Report Date: 10/21/2020
Date Signed: 10/21/2020 03:16:42 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 - LIBERTY ELEMENTARY SCHOOLFACILITY NUMBER:
376700048
ADMINISTRATOR:FATIMA CIFUENTESFACILITY TYPE:
840
ADDRESS:2175 PROCTOR VALLEY ROADTELEPHONE:
(619) 397-5225
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY:60CENSUS: 20DATE:
10/21/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Gillian GorelikTIME COMPLETED:
03:30 PM
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On 10/21/20 at 2:20pm, 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 the Program Director Gillian Gorelik and Department Head Miriam Martinez. There were 20 children and 4 staff members. This School Age Program currently operates at Liberty Elementary School in the following rooms: Building 200 (aka Y Room) and the Multi-Purpose room with the capacity of 60 and is requesting a capacity increase of 98 in new rooms: #406, #607 and the Library. 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. The children’s restrooms are located behind the Library and in the Y Room. Restrooms are safe and clean and are sufficient to accommodate the new requested capacity of 98 children. Staff stated a school staff custodian cleans the bathroom every 3 hours. A staff restroom is located behind the Library. 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 in the Y Room. 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 a canopy for shade is located outside the Multi-purpose room. Drinking water is available outside via water dispensers and disposable cups and refillable water bottles.

A fire clearance for 98 school age children (ages kindergarten – 12 years) was granted on 10/8/20.

An increase of capacity for 98 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: 10/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2020
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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