376600553-11-4-2020-20-CC-RGOU-BV2W4E-20201104155724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600553
Report Date: 11/04/2020
Date Signed: 11/04/2020 03:57:33 PM

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:	SO. BAY FAM. YMCA - THURGOOD MARSHALL		FACILITY NUMBER:	376600553
ADMINISTRATOR:	MARLEN BENITEZ		FACILITY TYPE:	840
ADDRESS:	2295 MACKENZIE CREEK ROAD		TELEPHONE:	(619) 870-6422
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	60	CENSUS: 14	DATE:	11/04/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Miriam Martinez		TIME COMPLETED:	04:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/04/20 at 03:15 p.m., Licensing Program Analyst (LPA), Rajani Goudreau arrived at the facility to conduct an unannounced Case Management – Licensee Initiated inspection for the purpose of a capacity increase. Upon arrival LPA, met with Department Head, Miriam Martinez and Director, Marlen Benitez and proceeded to tour the facility. During the visit there were 14 children in care. The facility is requesting a capacity increase of 84 school age children, serving ages kindergarten through 12 years old. This school-age program will operate at Thurgood Marshall Elementary in the following classrooms: #704, Auditorium, and the Library. Facility operates Monday through Friday from 7:00 a.m. to 4:30 p.m. Facility is exempt from square footage, toilet, isolation space, outdoor activity space, and fencing requirements, per, H&S 1596.806. The classrooms are equipped with appropriate furniture; including tables, chairs, bookshelves, and other materials for the use of children. There is a functioning carbon monoxide detector located in classroom #704 and a first aid kit with required supplies. Disinfectants, cleaning solutions, and other hazardous substances shall be kept inaccessible. Drinking water is available in the classrooms via water pitchers. Children bring refillable water bottles from home. The school provides Breakfast and Lunch. Children bring snacks from home. Required documents are posted in classroom #704. The facility will be utilizing boy's and girl's restrooms located near the Auditorium building and the #600 building. LPA informed Department Head and Director, children shall be escorted and supervised by staff to and from the restrooms. LPA discussed with Department Head and Director, any individuals who are employed with the school district that offer technical support to the children in care during distance learning activities shall not be left alone with the children in care and shall not be counted in the ratio. See LIC809-C continuation page...

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

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: SO. BAY FAM. YMCA - THURGOOD MARSHALL	FACILITY NUMBER: 376600553
	VISIT DATE: 11/04/2020

NARRATIVE

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The outdoor activity spaces consist of a grass and black top area located near the back of the school. Children will utilize the outdoor bench area near the Auditorium for eating and during outdoor activities. The shaded rest area outside consist of tree’s and gazebos. LPA inspected the surface of the outdoor activity space and is observed to be free of hazards. Drinking water is readily available out in the play area via water pitchers. LPA discussed proper supervision and placement of staff during outdoor activities to ensure the safety of children at all times. Facility currently has exclusive use of the outdoor play areas as the school is currently closed due to COVID-19. LPA informed Department Head and Director an updated plan of operation to ensure supervision is in place and exclusive use of the classrooms and activity space during indoor and outdoor activities will have to be submitted once the school opens for in-person instruction.

This facility provides Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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. Services are in place.

A fire clearance for 84 school aged children was granted on October 13,2020. School District letters approving use of the classrooms is on file. Classrooms #700 is located in in the #700 building.

No deficiencies issued during today's visit. LPA conducted an exit interview with Miriam Martinez. LPA discussed and provided the following: LIC809, LIC809-C, LIC9213-Notice of Site Visit and Appeal Rights. Notice of Site Visit shall be posted for 30 days from today's date. LPA observed Notice of Site Visit posted prior to exiting facility. A capacity increase for 84 school age children ages K-12 years old shall be granted after final file review.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC809 (FAS) - (06/04)

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