376700988-5-19-2025-20-CC-SWIS-DGTVZW-20250519165325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700988
Report Date: 05/19/2025
Date Signed: 05/19/2025 04:54:56 PM

Document Has Been Signed on 05/19/2025 04:54 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	SOUTH BAY FAMILY YMCA - ENRIQUE CAMARENA ELEM.		FACILITY NUMBER:	376700988
ADMINISTRATOR/ DIRECTOR:	SAMANTHA ACUNA		FACILITY TYPE:	840
ADDRESS:	1650 EXPLORATION FALLS DRIVE		TELEPHONE:	(619) 591-5500
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91915
CAPACITY: 112	TOTAL ENROLLED CHILDREN: 112	CENSUS:	DATE:	05/19/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:38 PM
MET WITH:			TIME VISIT/ INSPECTION COMPLETED:	05:00 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 5/19/2025 at 2:30 p.m. Licensing Program Analyst, Shannan Williams conducted an unannounced annual inspection and met with Site Supervisor, Sam Acuna. LPA disclosed the purpose of the inspection and toured the inside and outside of the facility. This is a before and afterschool program that operates year-round and full time during breaks. Days and hours of operation are Monday – Friday, 6:00 a.m. – 8:15 a.m and Monday-Thursday 2:30 p.m.-6:00 p.m. and Friday 1:00 p.m- 6:00 p.m.. There is one classroom in operation. The following ratios were observed: twenty four children with five (5) staff members. Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space and playground equipment is maintained, is in safe condition and is free of hazards. The area under high climbing equipment and slides had rubber cushioning to absorb falls. There is sufficient cushioning to absorb falls under and around play equipment. The playground area includes a shaded rest area for children through the use of canopies and trees. Toilet and hand-washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Rest area provided as needed/necessary. Facility has a functioning carbon monoxide detector that meets statutory requirements. The last fire/disaster drill was conducted and documented on 4/23/2025. The facility provides snacks. Menus are posted monthly. Food preparation areas are clean and safe. Notation of children’s allergies is accessible. All food is protected against contamination and any contaminated food is discarded immediately.

NAME OF LICENSING PROGRAM MANAGER: Cynthia Biszant
NAME OF LICENSING PROGRAM ANALYST: Shannan Williams
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SOUTH BAY FAMILY YMCA - ENRIQUE CAMARENA ELEM.	FACILITY NUMBER: 376700988
	VISIT DATE: 05/19/2025

NARRATIVE

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Director stated there are no bodies of water or on the premises and LPA did not observe any bodies of water. Director stated there are no firearms, weapons, or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible to children. No poisons were observed during the inspection.

A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

All required notices, forms and license(s) were posted. Capacity and limitations as specified on the license are being maintained. At least one person trained in EMSA approved Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher, designated to act in the director’s absence, has been reported to the Department. Children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full signature and record the time of day. Sign in/out sheets reviewed and observed by the LPA meet this regulation. Facility maintains a ratio of one teacher supervising no more than 12 children in care. This facility transports children. All required documentation is completed and was reviewed.
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 and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.
This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication, 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. 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 ttps://www.ada.gov/childqanda.htm.
Director stated no children enrolled require medication at this time.

NAME OF LICENSING PROGRAM MANAGER: Cynthia Biszant
NAME OF LICENSING PROGRAM ANALYST: Shannan Williams
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SOUTH BAY FAMILY YMCA - ENRIQUE CAMARENA ELEM.	FACILITY NUMBER: 376700988
	VISIT DATE: 05/19/2025

NARRATIVE

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

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with Site Supervisor, Sam Acuna, a report, along with Appeal Rights (LIC9058), were provided. A Notice of Site Visit was given and must remain posted for 30 days. LPA observed that the Notice of Site Visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Cynthia Biszant
NAME OF LICENSING PROGRAM ANALYST: Shannan Williams
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC809 (FAS) - (06/04)

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