384002434-9-23-2026-05-CC-CQUO-DY7RPV-20260923131233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002434
Report Date: 09/23/2026
Date Signed: 09/23/2026 01:12:47 PM

Document Has Been Signed on 09/23/2026 01:12 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH		FACILITY NUMBER:	384002434
ADMINISTRATOR/ DIRECTOR:	ALVAREZ, KATIA		FACILITY TYPE:	850
ADDRESS:	1011 GARFIELD STREET		TELEPHONE:	(415) 242-7135
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 16	CENSUS: 16	DATE:	09/23/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Shirley Li		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 September 23, 2026 at approximately 12:00pm, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, case management visit. LPA met with program director, Shirley Li, and explained the purpose of the visit. Present during LPA's visit included 4 teaching staff, program director, and mental health specialist with 16 preschool children. Facility director, Katia Alvarez, was not present. YMCA program operates at Lutheran Church of Our savior. YMCA program is licensed to operate in classrooms #1 through #4. During today's visit, classroom in operation was the Penguin classroom, which is one, large, open classroom in rooms #2, 3 and 4. The Sea Turtles classroom (room #1) was not in operation during today's visit. Executive director, Anne Senores, informed the department that backyard at facility will undergo renovation. Tentative schedule of renovation was to be from March 30, 2026 through July 17, 2026. During the backyard's renovation, children utilized the front court yard only. On March 19, 2026, LPA measured the front court yard for 1,714.72 square feet that allowed for a capacity of 22 children. A temporary outdoor rotation schedule for the front court yard usage was submitted to the department. Backyard renovation ended as of September 16, 2026. Program director maintained communication with LPA of renovation delays. (Continue report on page 2...)

Marie Rodriguez
Catrina Quimbo
	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 09/23/2026

NARRATIVE

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During today's visit, LPA inspected renovated backyard for health and safety hazards. LPA also remeasured renovated backyard. Backyard was measured for 2,392.95 square feet allowing for a capacity of 31 children. Front court yard and backyard measure for a combined total of 4,107.67 square feet which accommodates the total licensed capacity of 32 preschool children.

Entire backyard is fully enclosed and fenced. LPA observed fence to be new. Exit from backyard to street has not changed and remains available through a push door, if needed. LPA advised program director for a sound alarm system to be installed on exit door.

Backyard includes play structure that is wooden with resilient padding underneath. There is also a music wall, climbing hill, garden area, and sand pit for children's use. LPA observed sand pit to be covered when not in use. LPA reminded program director children must always be supervised when children utilize the climbing hill and wooden play structure. Floor in backyard includes corkeen, wood chips and rocks. LPA reminded program director children must always be supervised when children are running or walking near rocks. LPA did not observe any pools, spas or bodies of water on site. LPA also recommended a child safety gate for the garbage bins to be inaccessible to children.

Drinking water will be made available to children in the backyard with their individual water bottles that can be refilled on site.

During today's visit, program director provided LPA with an updated Emergency Disaster Plan (LIC610) and updated Facility Sketches (LIC999) for the backyard. Temporary outdoor rotation waiver is no longer required as outdoor square footage is sufficient for the licensed capacity.

No deficiencies were issued during today's visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Shirley Li.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC809 (FAS) - (06/04)

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