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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600051
Report Date: 04/14/2023
Date Signed: 04/14/2023 03:39:42 PM

Document Has Been Signed on 04/14/2023 03:39 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:SOUTH BAY FAMILY YMCA-CHULA VISTA HILLS ELEMENTARYFACILITY NUMBER:
376600051
ADMINISTRATOR:BLANCA RINCONFACILITY TYPE:
840
ADDRESS:980 BUENA VISTA WAYTELEPHONE:
(619) 482-7066
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 16DATE:
04/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Blanca RinconTIME COMPLETED:
03:45 PM
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On 4/14/23 at 2:45pm, LPA Adrian Castellon conducted a case management inspection. LPA Castellon met with facility staff Blanca Rincon and Sandra Hernandez and discussed the purpose of the inspection. There were 16 school age children present.

The purpose of the inspection is to deliver an amended report and citation for a report and citation issued on 12/9/22.

No citations issued on this date.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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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