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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105068
Report Date: 08/24/2026
Date Signed: 08/24/2026 04:06:54 PM

Document Has Been Signed on 08/24/2026 04:06 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:YMCA TEENS IN MOTION: RANCHO BERNARDO HIGHFACILITY NUMBER:
376105068
ADMINISTRATOR/
DIRECTOR:
SELENA ROMANFACILITY TYPE:
840
ADDRESS:13010 PASEO LUCIDOTELEPHONE:
(619) 873-7134
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 30TOTAL ENROLLED CHILDREN: 16CENSUS: 6DATE:
08/24/2026
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Tess WilliamsTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 8/25/26 at 1:45 pm, Licensing Program Analyst (LPA), Gerald Poindexter, conducted an unannounced annual inspection. LPA met with Tess Williams, director of adaptive programs. Site Director Selena Roman was unavailable due to scheduled leave. A tour of the facility was conducted. This special education, school-age program is located on a public high school site. LPA observed 6 school-age daycare children present with four staff members and Ms. Williams. The program operates in bungalow E14 located at Rancho Bernardo High School. A fire clearance was granted on 07/26/2021. Capacity at the facility is 30. he facility was within ratio and capacity at all times. Per Health and Safety Code Sections 1596.806(a), (a)(1), (1)(2) and (d) this program is exempt from square footage, fencing, outdoor activity space, toilet and isolation requirements. Outdoor play area includes grassy quad located near the center of the school.

Ms. William stated that while there is no dedicated playground space, the staff utilize the school campus for walks and other 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 refillable water jugs. Medications are kept in locked drawer and inaccessible to children. Classroom also has a complete first aid kit, operational refrigerator, and operational carbon monoxide detector. Facility provides PM snacks prepared in the classroom. Snacks are in a refrigerator and storage closet, both secured by safety latch. Classroom has a storage cabinet for cleaning supplies which are made inaccessible via safety latch. The program uses the bathrooms (girls and boys) in the Main Building (located approximately a one-minute walk away) that afford privacy. Sign-in (manual) area is located directly upon entering the classroom. All required postings were posted. LPA provided additional Parent’s Right poster. Facility representatives were reminded to keep anything that reads, “Keep Out of Reach of Children” to be inaccessible to children. Ms. Williams was CONTINUED ON PAGE 2

Joelle Redding
Gerald Poindexter
DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: YMCA TEENS IN MOTION: RANCHO BERNARDO HIGH
FACILITY NUMBER: 376105068
VISIT DATE: 08/24/2026
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reminded that any changes to the facility must be reported to and approved by Community Care Licensing. The program does not provide transportation.

Personnel and children's records were reviewed. LPA reviewed sign in/out sheets, a sample of personnel records and a sample of children's records. There is at least one staff present with current CPR and First Aid certification. Children are evaluated upon entry and monitored throughout the day for signs of illness.

The isolation area for ill children awaiting pick up is directors area inside or the outside bench area. Facility is reminded that the Mandated Reporter Training is to be retaken every two years and can be accessed at the following website: www.mandatedreporterca.com.

All personnel have required criminal record and child abuse index clearances. All staff members have the required immunizations and have completed mandated child abuse training. LPA reviewed Emergency Disaster Plan and the last emergency drill was conducted on 8/18/26. An updated roster was obtained during the inspection. Reporting requirements and AB633 was also reviewed.

Ms. Williams was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

CONTINUED ON PAGE 3

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: YMCA TEENS IN MOTION: RANCHO BERNARDO HIGH
FACILITY NUMBER: 376105068
VISIT DATE: 08/24/2026
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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/process.

No deficiencies sited.

Exit interview conducted and report was reviewed with Tess Williams, director of adaptive programs. A Notice of Site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Appeal Rights provided.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC809 (FAS) - (06/04)
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