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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604021
Report Date: 09/12/2023
Date Signed: 09/12/2023 03:24:34 PM


Document Has Been Signed on 09/12/2023 03:24 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:YMCA-EADER PROGRAM CENTERFACILITY NUMBER:
300604021
ADMINISTRATOR:SABEDRA-TAYLOR, MEGANFACILITY TYPE:
840
ADDRESS:9291 BANNING AVETELEPHONE:
(714) 968-3638
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:96CENSUS: DATE:
09/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Director, Andrea Hill TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Aiddee Nunez conducted a Case Management Inspection to investigate an Unusual Incident Report (UIR) which was self-reported to our office on 8/28/2023. Upon entry to the facility, LPA Nunez met with Director, Andrea Hill. When LPA arrived there were no children present. When the children arrived at 2:40 pm the director stated there were 39 school age children with 7 school age staff members. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Self-reported incident received on 8/28/2023 stated Child#1(C1) was on the climbing equipment and fell and hurt their left wrist. According to the director there were 2 staff members on the playground; however, they did not witness C1 fall.



The director, staff#1 (S1) stated S1 was not present on the day of the incident which happened on 8/25/23 at 1:20pm. Staff#2(S2) was the person in charge on the day of the incident. S1 also stated S2 is no longer working at the facility and S2 last workday was on 9/1/23.


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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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 09/12/2023 03:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: YMCA-EADER PROGRAM CENTER
FACILITY NUMBER: 300604021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
CCR
101229(a)(1)

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101229 Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child shall be left without the supervision of a teacher at any time, Supervision shall include visual observation.

This requirement is not met as evidenced by:

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The director stated they will do a supervision trraining and go over play ground rules and make sure they put cones around bars they are not allowed to play at. The director will provide the LPA a sheet with all the staff signatures that attended the training by the POC due date via email.
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Based on interviews conducted it was determined S3 and S4 did not provide adequate supervision while children were playing in the play structure. This poses a potential safety risk to children 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: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: YMCA-EADER PROGRAM CENTER
FACILITY NUMBER: 300604021
VISIT DATE: 09/12/2023
NARRATIVE
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During this investigation, LPA interviewed 3 staff, and 1 child. LPA also obtained a copy of the children’s roster, personnel report, a copy of the parent communication form, and examine and took pictures of the outdoor play structure. Through interviews conducted with child and staff, it was disclosed by 2 staff that were on the playground that none of the staff observe how C1 fell and injured themselves on the play structure. Staff #2 (S2) stated they did not observe how C1 fell due to S1 helping another child; however, S2 does not remember what action she was doing to help that child. S2 stated that S2 was notified by another child that C1 was hurt. Staff #3 (S3) stated they did not observe how C1 fell due to S3 checking a list and supervising the children playing football. S3 stated she learned that C1 was hurt when she heard it on the walkie talkie that C1 needed an ice pack. S2 and S3 disclosed that children are not allowed to use the parallel bars (monkey bars) from the play structure. S2 also disclosed that C1 had put on sunscreen and C1 said her hands were slippery and that’s why she slipped from the monkey bars. C1 disclosed none of the staff saw C1 fall. C1 said that C1 had put sunscreen on her face and C1 hands were slippery and that’s why C1 fell from the monkey bars. C1 said they are not supposed to use the monkey bars but can only hang from them.


Based on the information available to the LPA it is determined that the facility had violated Title 22 Regulation section 101229(a)(1) due to lack of supervision. The deficiency is being cited on the attached 809D.

This is a Type 'A' violation the Director shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Aiddee NunezTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC809 (FAS) - (06/04)
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