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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700142
Report Date: 05/05/2023
Date Signed: 05/05/2023 02:13:32 PM


Document Has Been Signed on 05/05/2023 02:13 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:TOBY WELLS YMCA DEVELOPMENTAL PRESCHOOLFACILITY NUMBER:
376700142
ADMINISTRATOR:TALANA LUGOFACILITY TYPE:
850
ADDRESS:5105 OVERLAND AVENUETELEPHONE:
(858) 496-9622
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:95CENSUS: 57DATE:
05/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Talana LugoTIME COMPLETED:
02:30 PM
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On 5/5/23 at 1:55 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management inspection to provide additional information regarding an unusual incident reported by the facility on 3/14/23. Upon arrival, LPA met with Director Talana Lugo and toured the facility. LPA observed appropriate capacity and ratios. LPA observed appropriate care and supervision of the children. Census was as follows:

Classroom #1: 10 children with staff member Brennan Russell
Classroom #2: 14 children with staff members Leslie Palacios and Jasmine Salazar
Classroom #3: 17 children with staff members Jesseca Serrano
Classroom #4: 16 children with staff members John Walker and Irma Roldan

Due to insufficient information and lack of disclosure by the child (C1) regarding the unusual incident, the case does not warrant a full investigation and no further action is required. The case assignment is completed. No deficiencies were cited at this visit.

Exit interview conducted and report was reviewed with facility representative Director Talana Lugo. Notice of site visit was provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023
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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