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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700048
Report Date: 12/06/2022
Date Signed: 12/06/2022 02:10:39 PM


Document Has Been Signed on 12/06/2022 02:10 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: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: 0DATE:
12/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jen SaldanaTIME COMPLETED:
02:15 PM
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On December 6, 2022 at 12:30 PM, Licensing Program Analyst (LPA) Gloria Gonzalez conducted an unannounced Case Management inspection to follow-up on a self-reported incident that occurred on or about 10/21/22.  LPA disclosed the purpose of the inspection and was granted a tour into the facility by Staff Member, Jordan Roberts. Site Supervisor, Jen Saldana arrived on or about 1:30 PM and continued the visit with LPA. There were 0 children and 3 staff members at the time of the inspection.

An unusual incident report (UIR) was submitted to the San Diego Regional Office (SDRO) on 10/25/22 alleging a possible lack of supervision. LPA conducted interviews with the Site Supervisor and staff members.  The incident was regarding Child #1 did not attend the facility after school. When parent picked up child #1, staff advised child did not attend. At about 5:50 pm child was found at near by park by authorities. Saldana states Child #1 will not be present at the facility today as parent advised staff.

Ms. Saldana was provided a copy of the appeal rights (LIC 9058). LPA provided the notice of site visit (LIC 9213) and observed it being posted at the facility.
 
An exit interview was conducted with Site Supervsor, Jen Saldana.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022
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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