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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701502
Report Date: 10/18/2021
Date Signed: 10/18/2021 11:01:54 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:YMCA TEENS IN MOTION: HELIX CHARTER HIGHFACILITY NUMBER:
376701502
ADMINISTRATOR:LUCELYNA GODWINFACILITY TYPE:
840
ADDRESS:7323 UNIVERSITY AVENUETELEPHONE:
(619) 873-7134
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:30CENSUS: 0DATE:
10/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lucelyna GodwinTIME COMPLETED:
11:15 AM
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On 10/18/2021 at 10:00am, Licensing Program Analyst (LPA), Martha Malane conducted an announced Pre-Licensing inspection. LPA met with Association Program Specialist, Lucelyna Godwin, Executive Manager, Shelby Gomez and Program Director, Redentor Comilang. A tour of the facility was conducted. This program will operate in Room 540 located at Helix Charter High School. A fire clearance was granted on 09/20/2021. The program will use the restroom located in the classroom which provides privacy. This program is exempt from square footage, fencing, outdoor activity space, toilet and isolation requirements. Outdoor area includes grass, shade provided by tress and tables. Mr. Comilang stated students and staff will also go on walks around the school for additional outdoor activities. The room is equipped with tables and chairs and age appropriate equipment and activities. Drinking water is readily accessible via water cups and water jugs. Medications will be kept in a locked box and inaccessible to children. There is a first aid kit with required supplies, operational refrigerator and carbon monoxide detector. Snacks are provided by the program and prepared in the classroom. Classroom has a storage cabinet in the kitchen for cleaning supplies which are made inaccessible via a lock. Sign-in area is located outside at the entry of the classroom. COVID-19 posters are posted. COVID-19 self-assessment guide was received and reviewed during inspection. Facility representatives were reminded that any changes to the facility must be reported to and approved by Community Care Licensing,

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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.

See 809-C for continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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: YMCA TEENS IN MOTION: HELIX CHARTER HIGH
FACILITY NUMBER: 376701502
VISIT DATE: 10/18/2021
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Ms. Godwin, Ms. Gomez and Mr. Comilang stated they understand all staff must have a criminal record clearance and be associated to the administrative site prior to having a presence in the center. Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on “Receive Important Updates,” then enter your email address and choose which program you would like to subscribe to and click subscribe.

An exit interview was conducted with Ms. Godwin, Ms. Gomez and Mr. Comilang. A copy of this report and appeal rights were provided. No corrections are needed at this site. A license for 30 children (ages 12-17 years) in Room 540 may be granted upon a final file review.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Martha MalaneTELEPHONE: (619) 767-2231
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
LIC809 (FAS) - (06/04)
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