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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105107
Report Date: 08/23/2022
Date Signed: 08/23/2022 01:03:58 PM

Document Has Been Signed on 08/23/2022 01:03 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DAVIS FAMILY YMCA - GAGE ELEMENTARYFACILITY NUMBER:
376105107
ADMINISTRATOR:M. OVERLAND-MCKAYFACILITY TYPE:
840
ADDRESS:6811 BISBY LAKE AVENUETELEPHONE:
(619) 873-7134
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 175TOTAL ENROLLED CHILDREN: 175CENSUS: 0DATE:
08/23/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Lucelyna GodwinTIME COMPLETED:
01:05 PM
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On August 23, 2022 at 11:05 a.m. Licensing Program Analyst (LPA) Leilani Curtis and Licensing Program Manager (LPM) Monica Cuddy conducted an announced Pre-Licensing inspection. LPA and LPM met with Applicant Lucelyna Godwin and proceeded to tour the facility. Also present was the designated Director, Melissa Overland-Mckay, who meets qualification requirements. The School-Age Program will operate in the following classrooms: Room #19, Library and Auditorium/Cafeteria. The first aid kit is kept in room #19. Medications will be stored in a locked cabinet, inaccessible to children in room #19. The isolation area for sick/ill children is located in the nurse's office. A fire clearance for a capacity of 175 children was granted on 7/27/22.

Age-appropriate supplies and equipment were observed available in all indoor and outdoor activity spaces. The after school program will use school restrooms. Toilet facilities shall not be utilized simultaneously by children of both sexes. There is a separate staff restroom. The cafeteria/auditorium contain refrigerators, a freezer and a wheel chair elevator which will remain locked when children are in care. Cleaning supplies and other toxic items are inaccessible to children through latches, locks and/or placed on high surfaces. There is an operational carbon monoxide detector located in room #19 and in the library. Drinking water is readily accessible via refillable water jugs and water fountains. This program will provide an afternoon snack. They have a refrigerator on order. Applicant understands that they are not to use food products requiring refrigeration until their refrigerator is installed. The outdoor space used will be the kindergarten playground, blacktop area within the school fenced area and the picnic and blacktop area outside the cafeteria/auditorium. These areas have age-appropriate play equipment and shade. This elementary campus has an agreement with the City of San Diego to use the playground located on the outside of the fenced areas as public city park outside of school hours. This area includes a large grass area and a blacktop with 3 climbing structures. The agreement allows the city to use the school grounds as a public park 30 minutes after school lets out and up to 30 minutes before school starts. The facility will not use the playground outside of the fenced area once the general public has access to the area.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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: DAVIS FAMILY YMCA - GAGE ELEMENTARY
FACILITY NUMBER: 376105107
VISIT DATE: 08/23/2022
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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.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA and LPM reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

No corrections are needed. A license for a capacity of 175 children may be granted after final file review.

Exit interview conducted and report was reviewed with the applicant, Lucelyna Godwin. Due to printer error the report and appeal rights will be emailed to the applicant.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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