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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700367
Report Date: 12/11/2019
Date Signed: 12/11/2019 06:09:09 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: 26DATE:
12/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Jeffrey ApalategeiTIME COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct an annual random inspection. Upon arrival LPA Baez met with Youth Development Teacher, Jeffrey Apalategei. The following ratios were observed:

Room 502 (Serves 5 years through 12 years of age):

  • There were 26 children present with 3 staff members

Multi- purpose Room (Serves 5 years through 12 years of age):
  • There were not any children or staff members present

Media Center/Library (Serves 5 years through 12 years of age):
  • There were not any children or staff members from the center present. Library was being used as the book fair during today's inspection.
Appropriate ratios and capacity were observed.

Furniture and age appropriate equipment is in good condition indoors and outdoors. Children have access to gender specific restrooms labeled "Boys" and "Girls" and is located on the elementary school campus near the porch area with lunch tables. The toilets and hand washing facilities are sanitary. The rooms are safe and clean. The center is responsible for providing snacks and the snack menu is posted. Drinking water is readily accessible inside of the classroom through the use of water jugs and disposable cups. Children have access to water outside of the classroom through water fountains. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, and are in good repair. The outdoor play area is fenced, children have access to the black top area which includes the following: covered porch area, tether ball courts, wall ball area, and basketball courts. The play area has a covered porch area used for shade. There are no bodies of water or weapons at this facility. The last emergency drill was conducted on 12/2019. There is an operational smoke detector and carbon monoxide detector at the facility. ...CONTINUED ON 809C...

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

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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-WOLF CANYON ELEMENTARY
FACILITY NUMBER: 376700367
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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-WOLF CANYON ELEMENTARY
FACILITY NUMBER: 376700367
VISIT DATE: 12/11/2019
NARRATIVE
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First Aid/CPR was reviewed and is in compliance. Staff records of education, training, and/or experience were reviewed and are in compliance.

LPA reviewed the following with Jeffrey Apalategei: IMS, SIDS, Car seat Law, and Shaken Baby Syndrome. This facility does provide Incidental Medical Services- IMS. A written plan of operation has already been submitted to CCL and is on file. The following information regarding ADA was provided, US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and http://www.ada.gov/childqanda.htm. LPA and Jeffrey discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

Immunization law (SB792) was discussed with Jeffrey and he understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Facility is compliant with SB792.

LPA Baez discussed the new Mandated Reporter training, AB1207. LPA Baez reminded Jeffrey that all staff members are to take the training and have the printed certificates present at the facility and available for review. Facility is compliant with AB1207.

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed the posting the Notice of Site Visit.

Duty Line: (619) 767-2248, Monday through Friday from 8am to 5pm. To access our Regulation and Forms please use our WEBSITE: http://ccld.ca.gov

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

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3