376701312-10-30-2020-20-CC-RGOU-BUVUF5-20201030153211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701312
Report Date: 10/30/2020
Date Signed: 10/30/2020 03:32:19 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 - MURAOKA ELEMENTARY		FACILITY NUMBER:	376701312
ADMINISTRATOR:	MICHELLE CASTELLANOS		FACILITY TYPE:	840
ADDRESS:	1644 SANTA ALEXIA AVENUE		TELEPHONE:	(619) 421-9622
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	75	CENSUS: 31	DATE:	10/30/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Miriam Martinez		TIME COMPLETED:	03:45 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 2:00 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, Valeria Rincon and proceeded to tour the facility. There were 31 children in care at time of visit. The facility is requested a capacity increase to 112 school age children, serving ages transitional kindergarten through 12 years old. This school-age program will operate at Saburo Muraoka Elementary in the following classrooms: #111, #117, #208, Multi-Purpose and Innovation Center. Facility operates 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 classroom #111 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. Children will bring refillable water bottles from home. The school provides breakfast, lunch and snacks. Required documents are posted in classroom #111. Last disaster drill was conducted on 10/10/20. The facility will be utilizing boy's and girl's restrooms located near the Multi-Purpose room and classrooms #111 and #208. The Innovation Center and the Multi-Purpose room are in separate buildings. Children shall be escorted and supervised by staff to and from the restrooms. The outdoor activity space is located on the black top and the grass area near the Multi-Purpose room. There is a shaded rest area for children by the use of gazebo's . 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. Discussed proper supervision and placement of staff on the playground to ensure the safety of children at all times. At this time the program has exclusive use of the outdoor play area due to the school currently closed. 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 - MURAOKA ELEMENTARY	FACILITY NUMBER: 376701312
	VISIT DATE: 10/30/2020

NARRATIVE

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This facility provide Incidental Medical Services. 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 and Applicant discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

A fire clearance for 112 school aged children was granted on October 15, 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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