376600781-10-27-2021-20-CC-LGAO-C8886Y-20211027221504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376600781
Report Date: 10/27/2021
Date Signed: 10/27/2021 10:15:21 PM

Document Has Been Signed on 10/27/2021 10:15 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 - MCMILLIN ELEMENTARY SCHOOL		FACILITY NUMBER:	376600781
ADMINISTRATOR:	JESUS GOMEZ		FACILITY TYPE:	840
ADDRESS:	1201 SANTA CORA AVENUE		TELEPHONE:	(619) 397-0103
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY: 98	TOTAL ENROLLED CHILDREN: 36	CENSUS: 21	DATE:	10/27/2021
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Site Supervisor		TIME COMPLETED:	06:00 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 10/27/21, at 2:05PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced continuation of a previous annual inspection visit and met with Site Supervisor Bianca Brugger. LPA advised the site supervisor of his return to complete the previous visit. This is a before and after school program which operates on a traditional school year schedule. Days and hours of operation are Monday-Friday from 6:00AM-8:15AM and 2:30PM-6:00PM. There is currently one classroom, room #201, in operation but the facility also has the library and auditorium as approved supervision areas. Site Supervisor Brugger stated that those areas currently are used minimally but can be used when needed. The facility's license indicates that room #506 is used as the primary day care room. However, analyst met with YMCA Program Coordinator Leo Cruz during last visit and was advised that room #201 has always been an approved room on the license and facility changed it to now be used as the primary classroom. Analyst did not find #201 to be a licensed room for the facility and Program Coordinator Cruz will be contacted and advised that a room change application will be required to be submitted. The following ratios were observed: today in room #201: 21 children were present under the supervision of the site supervisor Ms. Brugger and staff member, Olympia Kuglen. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination. Contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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: SOUTH BAY FAMILY YMCA - MCMILLIN ELEMENTARY SCHOOL	FACILITY NUMBER: 376600781
	VISIT DATE: 10/27/2021

NARRATIVE

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The program uses a black top yard area and field located at back end of campus for outdoor activities that are conducted under the supervision of the site supervisor and staff. The children also do stretches and running in a school playground area but do not use any of the play structures. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.The Department has inspection authority as specified in Health & Safety Code.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The current site supervisor for the facility, Bianca Brugger, is not currently listed as the facility's official site supervisor. The licensee has 30 days in which to submit a director's packet to CCL for Ms. Brugger for review and installation as recognized site supervisor for the program. The person who signs the children in/out of the facility shall use their full legal signature and record the time of day.

All personnel, including the licensee, administrator and volunteers, shall be in good health and are physically and mentally capable of performing assigned task. Personnel that pose a threat to the health and safety of children shall be relieved of their duties. All personnel are trained on housekeeping and sanitation principles, including universal health precautions or have related experience. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 14 children in care. The licensee ensures children with obvious symptoms related to fever or vomiting are not accepted. The facility is equipped to isolate and care for any child who becomes ill during the day.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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: SOUTH BAY FAMILY YMCA - MCMILLIN ELEMENTARY SCHOOL	FACILITY NUMBER: 376600781
	VISIT DATE: 10/27/2021

NARRATIVE

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This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and site supervisor discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no violations are being cited. An exit interview was conducted with Site Supervisor Brugger. Ms. Brugger was provided a copy of visit appeal rights (LIC 9058)

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

LIC809 (FAS) - (06/04)

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