376701007-1-4-2023-51-CC-ALMA-CMS3A5-20230104170410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701007
Report Date: 01/03/2023
Date Signed: 01/04/2023 05:04:28 PM

Document Has Been Signed on 01/04/2023 05:04 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:	RYAN FAMILY YMCA - BARNARD ELEMENTARY		FACILITY NUMBER:	376701007
ADMINISTRATOR:	MARISA HENSEN		FACILITY TYPE:	840
ADDRESS:	2445 FOGG STREET		TELEPHONE:	(619) 672-6932
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	90	CENSUS: 15	DATE:	01/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Marisa Hensen		TIME COMPLETED:	05:15 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 1/4/23 at 2:00 PM, Licensing Program Analysts (LPA) Adrian Mangina made an unannounced visit to the facility to conduct an annual inspection. Upon arrival LPA met with Site Director Marisa Hensen and proceeded to tour the facility. During today's inspection, there were 15 school-aged children with 1 Director acting as teacher and two aids in one room. Appropriate ratios and capacity were observed. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation. Floors appear to be clean and safe. Drinking water is readily accessible, Facility uses bottled water inside and water fountains outside. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. There is no food service area as children attend after lunch. Snacks are provided which are prepared in the classrooms. Adequate food is available for snacks. Snack menu is posted. Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting cover. Director states there are no poisons on premises. Director stated there are no firearms or other weapons on the premises. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility. Director states that she cannot find the disaster drill log, but she the last fire drill was conducted on 9/1/22 or 9/15/22. Facility Representative reminded to maintain drill records for at least 1 year. The fire department last inspected the facility on 9/29/22. Outdoor play area is a fenced playground with sufficient material for cushioning. Facility has a waiver to share bathrooms with other after school programs. There are no bodies of water at this facility. Climbing structures, swings and slides are securely fixed to the ground. Area has adequate shading. Equipment is age appropriate. Area has drinking water readily accessible and grounds are free of debris or potential hazards. continued on LIC809 page 2

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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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Document Has Been Signed on 01/04/2023 05:04 PM - It Cannot Be Edited

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: RYAN FAMILY YMCA - BARNARD ELEMENTARY	FACILITY NUMBER: 376701007
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as staff #3 has no health screening which poses potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/01/2023
	Plan of Correction
1 2 3 4	Facility Representative states will ensure staff #3 has signed health screening and will provide to LPA no later than close of business 2/1/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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: RYAN FAMILY YMCA - BARNARD ELEMENTARY	FACILITY NUMBER: 376701007
	VISIT DATE: 01/03/2023

NARRATIVE

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LIC809 page 2

There are no children who take medication. LPA reviewed medication storage area which is locked. At least one staff member has current CPR and First Aid certifications. One staff is missing signed health screening. All staff have required immunizations and have completed Mandated Reporter training within last two years. Each personnel record contains documentation of educational background and training. Sign ins were reviewed. Children’s records contain admission agreements and medical assessment. A review of staff records on this date indicates that all staff members are associated to the facility. All facility staff who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Facility representative 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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. Facility has an Incidental Medical Services Plan. LPA reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

continued on LIC809 page 3

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

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: RYAN FAMILY YMCA - BARNARD ELEMENTARY	FACILITY NUMBER: 376701007
	VISIT DATE: 01/03/2023

NARRATIVE

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LIC809 page 3

Pursuant to Title 22 of the CA Code of Regulations, one type B deficiency was cited see LIC809- D and LIC9102 for Technical Violation given

Exit interview conducted and report was reviewed with the facility representative, Marisa Hensen A notice of site visit was given and must remain posted for 30 days.

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/inspection-process.

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L Mangina	TELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023

LIC809 (FAS) - (06/04)

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