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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610624
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:42:53 PM


Document Has Been Signed on 07/28/2023 02:42 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CENTRAL ORANGE COAST YMCA - MARINERS SCHOOLFACILITY NUMBER:
300610624
ADMINISTRATOR:MEDINA, ELIZABETHFACILITY TYPE:
840
ADDRESS:2100 MARINERS DRIVETELEPHONE:
(949) 548-6770
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:36CENSUS: 27DATE:
07/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Natalia Huerta, Director TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Patricia Duron conducted a Case Management Inspection to investigate an Unusual Incident Report (UIR) which was self-reported to our office on 7-13-23. Upon entry to the facility, LPA Duron met with Director, Natalia Huerta. LPA observed 27 school age children in care with 7 school age staff members providing care and supervision. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. 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 7-13-23 stated Child 1 (C1) was touched inappropriately by Child 2 (C2) inside the facility at the carpet area, as children watched TV. During today's inspection LPA Duron interviewed 3 staff members and 4 children. Based on information that was obtained at the facility, S1 walked away to get a drink of water, when S1 returned, C1 informed S1 that C2 touched child inappropriately. S1 immediately informed S2 of incident. S2 spoke to C1 and C2 individually. S2 informed C1 and C2 parents/authorized representatives. C2 was picked up from school by parent and C1 remained at the facility. S2 stated both C1 and C2 are now kept separately, and are no longer in the same room at the same time. S2 stated the reported incident has not occurred again after that day.

In the areas that were evaluated, no deficiencies were cited for this case management inspections of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was conducted with the director. The Notice of Site Visit was posted. The Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The Director was provided a copy of their Appeal Rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Director was informed all appeals must be in writing and received by the Licensing office within 15 business days. End of Report.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Patricia DuronTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2023
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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