376700056-5-3-2023-20-CC-LGAO-CRH2UD-20230503174211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700056
Report Date: 05/03/2023
Date Signed: 05/03/2023 05:42:19 PM

Document Has Been Signed on 05/03/2023 05:42 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-HEDENKAMP ELEMENTARY SCHOOL		FACILITY NUMBER:	376700056
ADMINISTRATOR:	RYON WHITE		FACILITY TYPE:	840
ADDRESS:	930 EAST PALOMAR STREET		TELEPHONE:	(619) 397-5828
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	112	CENSUS: 14	DATE:	05/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Site Supervisor Claudia Solis		TIME COMPLETED:	05:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/03/23, at 2:30 PM, Licensing Program Analyst (LPA) Luigi Gargaro, conducted an unannounced annual inspection and met with facility site supervisor Claudia Solis. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a before and after school program which operates in conjunction with the co-located elementary school. The morning program operates from 6:00AM to 8:45AM and the afternoon program operates from 2:55PM to 6:00PM. The program primarily operates in the "Y" classroom and multi-purpose room located in the 200 building for the current thirty-one school age children enrolled in it. Facility also has elementary classrooms #307, #505, #705 and the library available when needed for supplemental activity space but the classrooms were locked and inaccessible during today's visit and site supervisor Solis advised analyst they are typically not used for the program but can be when needed. The children use the blacktop, lunch table and field areas immediately behind the "Y" classroom for outdoor activity. The following ratios were operating during today's visit: fourteen school age children were supervised by teachers Melissa Garcia and Cecilia Quiros as well as site supervisor Solis. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. All disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. Drinking water is available both indoors and outdoors. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The Department has inspection authority as specified in Health & Safety Code.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SOUTH BAY FAMILY YMCA-HEDENKAMP ELEMENTARY SCHOOL	FACILITY NUMBER: 376700056
	VISIT DATE: 05/03/2023

NARRATIVE

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A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The current site supervisor for the facility, Claudia Solis, is not listed as the facility's official site supervisor but the facility has a posted copy of the designation of facility responsibility form (LIC 309) indicating Ms. Solis' title. Adminstrator stated a change of director packet was sent to Licensing when the current director change was made. The licensee has 30 days in which to resubmit a director's packet to CCL for Ms. Solis for review and installation as recognized site supervisor for the program.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All personnel, including the licensee, administrator and volunteers, shall be in good health and are physically and mentally capable of performing assigned task. Personnel that pose a threat to the health and safety of children shall be relieved of their duties. All personnel are trained on housekeeping and sanitation principles, including universal health precautions or have related experience. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 14 children in care. The licensee ensures children with obvious symptoms related to fever or vomiting are brought to elementary school nurse's office. The facility is equipped to isolate and care for any child who becomes ill during the day.

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. The analyst reviewed staff files which contained health screening, required immunization records and current documentation of completed mandated reporter training.

LPA reviewed storage of medication and 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. The facility has a documented IMS plan in place. 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 https://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SOUTH BAY FAMILY YMCA-HEDENKAMP ELEMENTARY SCHOOL	FACILITY NUMBER: 376700056
	VISIT DATE: 05/03/2023

NARRATIVE

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LPA and site supervisor Solis discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts, Forms and Regulations.

No violations were cited during today's visit. An exit interview was conducted with Site Supervisor Solis and she was provided a copy of the facility's appeal rights (LIC 9058).

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC809 (FAS) - (06/04)

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