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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701502
Report Date: 02/11/2025
Date Signed: 02/11/2025 04:17:32 PM

Document Has Been Signed on 02/11/2025 04:17 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:YMCA TEENS IN MOTION: HELIX CHARTER HIGHFACILITY NUMBER:
376701502
ADMINISTRATOR/
DIRECTOR:		TESS WILLIAMSFACILITY TYPE:
840
ADDRESS:7323 UNIVERSITY AVENUETELEPHONE:
(619) 873-7134
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 30TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
02/11/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Kara OstrokolowiczTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 2/11/2025 at 2:30pm, Licensing Program Analysts (LPAs), Vicky Williamson and Raina Alexanian conducted an unannounced case management inspection for the purpose of inspected two room additions. LPA met with Site Supervisor Kara Ostrokolowicz and disclosed the purpose of the inspection. Also present was (1) Youth Development Teacher and three (3) students. This program operates on a traditional school year schedule. Days and hours of operation are Monday through Thursday, 1:45pm - 5:00pm and Friday, 2:30pm - 5:00pm.

LPA accompanied by Site Supervisor conducted a tour of the facility. The program currently operates in Room 540 located at Helix Charter High School. A fire clearance was granted on 9/20/2021. Licensee Representative, Lucelyna Godwin submitted a request to add Room 580 and the Sensory Room. A fire clearance was granted on 1/29/2025. Room 580 is located adjacent to Room 540 and the sensory room is located between Room 540 and 580. The program will use the restroom located between both classrooms which provides privacy. This program is exempt from square footage, fencing, outdoor activity space, toilet and isolation requirements. Outdoor area includes grass, tables and shade is provided by trees and a tent. Site Supervisor stated that students and staff will also go on walks around the school for additional outdoor activities. Room 540 and Room 580 are equipped with tables, chairs and age-appropriate equipment and activities. Sensory Room is equipped with padding around the lower walls, a swing/hammock, bean bag chairs, small trampoline and rubber exercise balls.

Drinking water is available both indoors and outdoors. Students bring their own water bottles. Site Supervisor stated that snacks are provided by the program and prepared in the classroom. The classroom has a storage cabinet in the kitchen for cleaning supplies which are made inaccessible by a key lock. There is also a storage shed located outside the facility used for items stored by the program staff. Medications are kept in a locked storage and inaccessible to children. There is a first aid kit with required supplies, operational refrigerator, and carbon monoxide detector. Sign-in/sign out sheets are located inside of the classroom.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: YMCA TEENS IN MOTION: HELIX CHARTER HIGH
FACILITY NUMBER: 376701502
VISIT DATE: 02/11/2025
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Site Supervisor was reminded that any changes to the facility must be reported to and approved by the Department.

There are two in-ground swimming pools located on the premises. LPA observed two in ground swimming pools located outside of building 700 with over 5 feet high fencing enclosing the bodies of water, the fence does not obscure the pool from view. The gates swing away from the pools, are self-closing and has a self-latching device. There is one main gate entrance located directly outside of the backside of building 700 and 4 additional gates located around the fencing. The gates require a key to open and have padlocks attached. Site Supervisor stated that the students do not utilize the pools located on the premises.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Site Supervisor was advised that Room 580 and the Sensory Room are ready for use. Site Supervisor is reminded to ensure that disinfectants, cleaning solutions, medication, and other hazardous items are made inaccessible to children.

Exit interview was conducted and report was reviewed with Site Supervisor Kara Ostrokolowicz. Appeal Rights, and Notice of Site Visit were given. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed Notice of Site Visit posted on the bulletin board inside of the classroom.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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