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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701502
Report Date: 09/25/2024
Date Signed: 09/25/2024 04:18:02 PM

Document Has Been Signed on 09/25/2024 04:18 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: 7CENSUS: 4DATE:
09/25/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Olivia KernTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On 9/25/2024 at 3:20pm, Licensing Program Analyst (LPA), Vicky Williamson conducted an unannounced case management inspection for the purpose of citing for deficiencies observed during an inspection at the facility 9/10/2024. LPA met with Olivia Kern, Youth Development Teacher. LPA disclosed the purpose of the inspection. There were four (4) clients present with two (2) Youth Development Teachers and one (1) Youth Development Aide.

During an inspection at the facility on 9/10/24 and during today's inspection, LPA observed that the facility was operating beyond the conditions and limitation specified on the license. LPA observed present in classroom 540, Client 1 (C1) who is 19 years of age and Client 2 (C2) who is 20 years of age both of whom have been enrolled in the program since October 2021. The facility license serves clients 12 – 17 years old.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, deficiencies are being cited on the attached LIC 809D.

Exit interview was conducted and report was reviewed with Olivia Kern, Youth Development Teacher. 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: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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Document Has Been Signed on 09/25/2024 04:18 PM - It Cannot Be Edited


Created By: Vicky Williamson On 09/25/2024 at 03:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: YMCA TEENS IN MOTION: HELIX CHARTER HIGH
FACILITY NUMBER: 376701502

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
101161(a)

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Limitations on Capacity (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evidenced by:

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Olivia Kern, Youth Development Teacher stated that she will ensure that Site Supervisor Tess Williams is advised that a request for an age exception for Client 1 and Client 2, must be submitted to the SDRO, no later than 10/4/2024.
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Based on record review, the licensee did not comply with the section cited above in that the facility operated beyond the... limitations specified on the license... by enrolling C1 who is 19 y/o and C2 who is 20 y/o which poses a potential health, safety or personal rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024


LIC809 (FAS) - (06/04)
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