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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700148
Report Date: 07/12/2023
Date Signed: 07/12/2023 09:58:15 AM

Document Has Been Signed on 07/12/2023 09:58 AM - 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 DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LA JOLLA YMCA - LA JOLLA ELEMENTARYFACILITY NUMBER:
376700148
ADMINISTRATOR:ERICK WHITEFACILITY TYPE:
840
ADDRESS:1111 MARINE STREETTELEPHONE:
(858) 454-7196
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 0DATE:
07/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucelyna Godwin TIME COMPLETED:
10:10 AM
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On 7/12/23 at 9:00 AM Licensing Program Analyst (LPA) Annette Sutherland conducted a case management inspection at the facility at Licensee’s request. Licensee has requested to use temporary classrooms while the school is under construction from 8/21/23 through 12/1/23. Upon arrival, LPA Sutherland met with facility representative Lucelyna Godwin (Program Specialist) and Shantrell Scott (Director McKinney YMCA.). This school-age program is located on an Elementary School Site (La Jolla Elementary). There were no daycare children present at the facility at time of inspection as school is closed for summer.

During this visit, LPA inspected the temporary classrooms: T1, T2, T3. Fire clearance is pending. First Aid Kit is located in a locked cabinet in classroom T1 along with any medications that the facility might have. Both are kept inaccessible from children. Classroom T1 will be the main hub of the three temporary classrooms. Facility sign-in and outs will be located in room T1.

Per H&S Code 1596.806, facility is exempt from square footage, toilet, isolation space, outdoor activity space and fencing requirements. All indoor and outdoor activity space utilized for the school age children were inspected. Rooms T1, T2 and T3 were observed to have age-appropriate furniture and equipment, including tables, chairs, bookshelves and other activity supplies for the children. Rooms have hooks and shelves for children’s belongings inside and outside. LPA observed separate bathrooms with privacy.



There is a separate bathroom utilized for ill children in nurse's office. There is an operational carbon monoxide detector located in each classroom. Snack menu will be posted, as well as all other required documents. Snacks are located inside a locked cabinet labeled in Room T2. Fridge in room T2 for any snacks items to be kept cold.

The outdoor playground area was inspected. Area has trees & canopies for shade. Children will be using the blacktop and have portable ball cart with equipment that will be brought back and forth to the area daily.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LA JOLLA YMCA - LA JOLLA ELEMENTARY
FACILITY NUMBER: 376700148
VISIT DATE: 07/12/2023
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Drinking water will be readily accessible inside and outside the classroom via portable brita filters. LPA advised Lucelyna Godwin and Shantrell Scott to advise Licensing once construction is completed as an LPA will need to inspect the new playground and new classrooms before they can be used. Facility representative is reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

No deficiencies were cited at this inspection.

Upon final file review and fire clearence, Rooms T1, T2 and T3 may be approved for use by the facility and added to the license. Exit interview conducted and report was reviewed with facility representative Lucelyna Godwin and Shantrell Scott. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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