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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700048
Report Date: 05/25/2021
Date Signed: 05/25/2021 12:18:49 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:98CENSUS: 35DATE:
05/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Fatima CisfuentesTIME COMPLETED:
12:30 PM
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On 05/25/2021 at 11:19 am, Licensing Program Analysts (LPA), Julissa Valle and Adrian Castellon conducted an unannounced virtual case management inspection via FaceTime due to COVID-19 and met with site supervisor, Fatima Cisfuentes. There were 35 children and four (4) staff member at the time of the inspection.

The purpose of the inspection was to follow-up on a self reported incident on 04/30/2021 in which there was a verbal altercation between several children. According to the incident report, child #1 and child #2, began name calling and made child #3 cry, during a game of kickball. Child #3 made his parents aware of his feelings and the father of child #3 called the police to make a report of the situation. Staff and children were interviewed on this date. The facility responded timely and adequately to the incident.

Additional follow-up is needed.

No deficiencies issued during today’s inspection.

An exit interview was conducted with the site supervisor. LPAs discussed and will provide the LIC809 and notice of site visit LIC9213 via email. The site supervisor was advised that acknowledgement of receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Julissa ValleTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
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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