376700367-10-30-2020-20-CC-RGOU-BUVSUC-20201030141054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700367
Report Date: 10/30/2020
Date Signed: 10/30/2020 02:11:01 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 ELEMENTARY		FACILITY NUMBER:	376700367
ADMINISTRATOR:	GOMEZ, MARIANA		FACILITY TYPE:	840
ADDRESS:	1950 WOLF CANYON LOOP		TELEPHONE:	(619) 482-8877
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	85	CENSUS: 23	DATE:	10/30/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Miriam Martinez		TIME COMPLETED:	02:20 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 10/30/20 at 1:00 p.m., Licensing Program Analyst (LPA), Rajani Goudreau arrived at the facility to conduct a Case Management – Licensee Initiated inspection for the purpose of a capacity increase. Upon arrival LPA, met with Department Head, Miriam Martinez and Director, Mariana Gomez and proceeded to tour the facility. During the visit there were 23 children in care. The facility is requesting an increase capacity of 112 school age children, serving ages transitional kindergarten through 12 years old. This school-age program will operate at Wolf Canyon Elementary in the following classrooms: Child Care Room (located in the #200 building), Multi-Purpose Room, Media Room, #304, #502, #603. Facility plans to operate from Monday - Friday from 7:00 a.m. to 4:30 p.m. Facility is exempt from square footage, toilet, isolation space, outdoor activity space, and fencing requirements, per, H&S 1596.806. The classrooms are equipped with appropriate furniture; including tables, chairs, bookshelves, and other materials for the use of children. There is a functioning carbon monoxide detector located in the Child Care room and a first aid kit with required supplies. Disinfectants, cleaning solutions, and other hazardous substances shall be kept inaccessible. Drinking water is available in the classrooms via water pitchers. Water bottles will be brought from home and refilled, if needed. The school currently provides the children with Breakfast, Lunch and Snacks. Required documents including menus are posted in the Child Care room. The facility will be utilizing boy's and girl's restrooms located near the Media Room and the Child Care room. Children are to be escorted and supervised by staff to and from the restrooms. Last Disaster drill was conducted on 08/17/20. The outdoor activity space is located in the back of the school. Children will utilize the black top and grass area for outdoor play. There is shaded rest area for children by the use of tree's and a gazebo. The surface of the outdoor activity space is observed to be free of hazards. Drinking water is readily available during outdoor play via water pitchers. LPA discussed proper supervision and placement of staff on the playground to ensure the safety of children at all times. See LIC809-C continuation page…

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

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 - WOLF CANYON ELEMENTARY	FACILITY NUMBER: 376700367
	VISIT DATE: 10/30/2020

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS plan has been submitted and approved. 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 link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

A fire clearance for 112 school aged children was granted on October 06, 2020. However, due to changes in the names of the classrooms an updated fire clearance will have to be obtained.

No deficiencies issued during today's visit. LPA conducted an exit interview with Miriam Martinez. LPA discussed and provided the following: LIC809, LIC809-C, LIC9213-Notice of Site Visit and Appeal Rights. Notice of Site Visit shall be posted for 30 days from today's date. LPA observed Notice of Site Visit posted prior to exiting facility. A capacity increase of 112 school age children ages K-12 years old shall be issued after the updated fire clearance is received reflecting correct names of classrooms.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

LIC809 (FAS) - (06/04)

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