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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701236
Report Date: 10/23/2019
Date Signed: 10/23/2019 05:26:43 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:MISSION VALLEY YMCA-OLD TOWN ACADEMYFACILITY NUMBER:
376701236
ADMINISTRATOR:FLENT ADLEANFACILITY TYPE:
840
ADDRESS:2120 SAN DIEGO AVENUETELEPHONE:
(619) 298-3576
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:70CENSUS: 19DATE:
10/23/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Rebecca Hunter and Adam Hakes Program Coordinators, Ashley Jacklin/teacher TIME COMPLETED:
05:35 PM
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(3) Licensing Program Analyst (LPA) Selina Siao conducted an unannounced three years inspection. Upon arrival, LPA met with teacher Ashley Jacklin (Ms. AJ) in the multi purpose room (MPR) who was with 12 children and Program Coordinator Rebecca Hunter returned back with 7 children from the restroom located on the second floor. All required notices, forms and license were posted. Furniture and age appropriate equipment is in good condition. Rooms have adequate lighting, ventilation and drinking water from an operational water fountain. There is a backpack rack to store the children's backpacks. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Facility has a cabinet to store snacks for the week which is clean and free of hazards. Snack menu is posted. Adequate food is available for snacks. Cleaning supplies are kept in a locked cabinet. Outdoor play area is a fenced playground turf and black top area located directly outside the MPR. The children do not use the play structure located between the turf and blacktop area. Area has a large tree used for shade. Portable water is available for children when the are outside. LPA reviewed sign in sheets, first aid supplies and reviewed medication policy and storage, all areas are within compliance. Isolation area is by the table in the MPR. Personnel and client records were reviewed. Reporting requirements was also reviewed. All personnel have required criminal record and child abuse index clearances. LPA reviewed Emergency Disaster Plan and last fire drill was conducted on 09/19/2019. Facility has an operating carbon monoxide detector.

Facility has at least one staff member that has a valid EMSA approved CPR/FA when children are in care. All staff members have the required immunizations records available for review.

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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 2
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: MISSION VALLEY YMCA-OLD TOWN ACADEMY
FACILITY NUMBER: 376701236
VISIT DATE: 10/23/2019
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and 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

The following items were discussed with facility representative: corporal punishment, smoking are not allowed in day care. Information about Heat Related Illness, best practice on supervision, latest car seat poster and effects of lead exposure and reporting responsibilities were discussed.

The following handouts were provided to the licensee today:

· PIN 19-10-CCP – U.S. Consumer Product Safety Commission recall


· PIN 19-09-CCP – Head Lice Information for Child Care Providers
· Health & Human Services Agency Guidance on Head Lice Prevention and Control
· PIN 19-08-CCP – CA Department of Public Health New Pre-Kindergarten Immunization requirements
· PIN 19-06-CCP – U.S. Consumer Product Safety Commission recall
· PIN 19-02-CCP – Safe Sleep Awareness Campaign

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov. LPA discussed California Megan's Law with facility representative : www.meganslaw.ca.gov.

An exit interview was conducted, and appeal rights were provided. A notice of site visit was provided and to be posted at the facility for 30 days. . Failure to keep notice posted will result in a civil penalty of $100.00

**The facility appears to be in substantial compliance during today's inspection**

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2