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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701470
Report Date: 12/21/2020
Date Signed: 12/21/2020 10:33:28 AM

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:COPLEY-PRICE FAMILY YMCA-INFANT PROGRAMFACILITY NUMBER:
376701470
ADMINISTRATOR:CRISTINA JIMENEZFACILITY TYPE:
830
ADDRESS:4300 EL CAJON BOULEVARDTELEPHONE:
(619) 280-9622
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:20CENSUS: 0DATE:
12/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Cristina JimenezTIME COMPLETED:
10:05 AM
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On December 21st, 2020 at 09:50 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management to ensure the facility’s receipt of Provider Information Notice (PIN) 20-24-CCP/ Safe Sleep. LPA advised the Director of the meeting’s purpose. Due to the COVID 19 outbreak, this inspection was done as a tele visit via the FaceTime platform. Present in the daycare were zero (0) infants.

LPA electronically provided the Director with PIN 20-24-CCP and a blank copy of form LIC 9227 Individual Infant Sleeping Plan. The Director reported that when the infants' classroom opens for use, staff will utilize the LIC 9227 Individual Sleeping Plan form.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. LPA will electronically provide this document to the Director. An exit interview was conducted. A copy of this report and Licensee/Appeal Rights (LIC 9058) will be e-mailed to the Director. The Director was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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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