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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600265
Report Date: 06/28/2024
Date Signed: 06/28/2024 08:32:15 AM

Document Has Been Signed on 06/28/2024 08:32 AM - 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:EAST COUNTY FAMILY YMCA BENCHLEYFACILITY NUMBER:
376600265
ADMINISTRATOR/
DIRECTOR:
KAYLENE SHAKEFACILITY TYPE:
840
ADDRESS:6269 TWIN LAKE DRIVETELEPHONE:
(858) 531-4218
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 0DATE:
06/28/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Lucelyna Godwin & KayleneTIME VISIT/
INSPECTION COMPLETED:
08:45 AM
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On 6/28/24 at 8:00 AM, Licensing Program Analyst (LPA) Keturah Lane conducted an announced inspection at Licensee’s request to add a classroom (and remove one classroom) to/from the license. Upon arrival, LPA met with facility representative Lucelyna Godwin (Association Program Specialist of Child & Youth Development for YMCA CRS) and Kaylene Shake YMCA Coordinator and toured the new classroom. There were no daycare children present for this program as it is not operating during the summer. Licensee requested approval prior to the start of the school year on August 12, 2024.

The facility is currently licensed for rooms: B3, B4, Library and Café/Auditorium. The facility has requested to remove B3 from the license and add Room 10. The current capacity of 160 will remain the same. Fire clearance was granted on 6/26/24 for Room 10, B4, Library and Café/Auditorium. LPA also received updated LIC500 personnel report stating Natasha Delia as Site Supervisor and an updated LIC610 Emergency Disaster Plan. Per H&S Code 1596.806, facility is exempt from square footage, toilet, isolation space, outdoor activity space and fencing requirements. Facility representative is reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

During this visit, LPA inspected the classroom 10 and bathrooms. Room 10 was observed to have age-appropriate furniture and equipment, including tables, bookshelves and other activity supplies for the children. First Aid Kit/Medication are carried on staff members. Both are kept inaccessible from children. Facility sign-in and outs will be located in room B4. LPA observed separate bathrooms with privacy. There is a separate bathroom utilized for ill children in the nurse's office. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: EAST COUNTY FAMILY YMCA BENCHLEY
FACILITY NUMBER: 376600265
VISIT DATE: 06/28/2024
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There is an operational carbon monoxide detector located in each classroom. Snack menu is posted, as well as all other required documents. Snacks and refrigerator are located in room B4.

There were no deficiencies cited at this inspection. Based upon inspection, LPA has approved classroom 10 to be added to the license and to remove classroom B3. An updated license will be mailed to Lucelyna Godwin next week.

Exit interview conducted and report was reviewed with the facility representative Lucelyna Godwin and Kaylene Shake. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
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