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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700367
Report Date: 12/17/2019
Date Signed: 12/17/2019 05:37:56 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-WOLF CANYON ELEMENTARYFACILITY NUMBER:
376700367
ADMINISTRATOR:EVELYN MURILLOFACILITY TYPE:
840
ADDRESS:1950 WOLF CANYON LOOPTELEPHONE:
(619) 482-8877
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:85CENSUS: 13DATE:
12/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Mariana GomezTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct a case management inspection. Upon arrival LPA Baez met with Director Mariana Gomez. There were 13 children and 5 staff members present during today's inspection.

The purpose of today's inspection is to deliver an amended report for the annual inspection that was conducted on 12/11/2019. The type B deficiency has been removed from the annual inspection dated 12/11/2019. There were not any deficiencies issued throughout today's inspection. Notice of Site Visit is to be posted for 30 days, LPA observed Director post the Notice of Site Visit.

SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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