300611755-1-21-2021-06-CC-JHAN-BXN36T-20210126165852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300611755
Report Date: 01/21/2021
Date Signed: 01/21/2021 03:21:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Sherene Hawkins

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20201124123142

FACILITY NAME:	CAPISTRANO BEACH CITIES YMCA- PALISADES		FACILITY NUMBER:	300611755
ADMINISTRATOR:	FITZPATRICK, CAROLE		FACILITY TYPE:	840
ADDRESS:	26462 VIA SACRAMENTO		TELEPHONE:	(949) 496-1627
CITY:	CAPISTRANO BEACH	STATE: CA	ZIP CODE:	92624
CAPACITY:	90	CENSUS: 19	DATE:	01/21/2021
		UNANNOUNCED	TIME BEGAN:	02:43 PM
MET WITH:	Tyler Fauls-Rivas		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Day care child injured another day care child due to a lack of supervision

INVESTIGATION FINDINGS:

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Tele-Inspection- COVID-19 State of Emergency

Licensing Program Analyst (LPA) S. Hawkins conducted a follow up investigation regarding a complaint of lack of supervision allegation which was initiated on 12/01/20. During today’s tele-visit (via face time) a virtual tour of the facility was conducted and LPA provided the complaint findings to the Director Tyler Fauls-Rivas. The current census observed was 19 children with 2 staff. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 11/24/20 the Department received a complaint alleging that a school age child injured another school age child due to a lack of supervision. It was reported that a child was stabbed by another child while in care due to staff being distracted while supervising the children. ***Contined on page 2***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20201124123142

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO BEACH CITIES YMCA- PALISADES	FACILITY NUMBER: 300611755
	VISIT DATE: 01/21/2021

NARRATIVE

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**page 2**

During the investigation, LPA interviewed 4 staff, 8 parents, 7 children and reviewed facility records. Staff and children interviewed both reported that S1 was present supervising room Y1 children on the playground and witnessed the incident as it occurred. S1 added that they were walking the perimeter of the playground field supervising the children as they were playing. Both children involved in the incident were initially playing together, they became mad at one another and one of the children involved found a pencil that was left on the playground (shared school elementary playground) and attacked the other child piercing the child in the chest once. S1 stated he removed the children from the group and provided first aid to the injured child. S1 stated that the injury slightly broke the skin of the child. S1 reported that both parents were informed of the incident, staff followed up with the parents of the injured child, and to the facility’s knowledge medical attention was not sought. Facility director addressed behavior concerns with the parent and child was given a 5 day suspension. Both children directly involved in the incident declined to be interviewed. Children interviewed added that staff are always present watching the children. Parents interviewed were satisfied with the care and supervision being provided to the children and had no concerns.
This agency has investigated the complaint alleging that a day care child injured another day care child while in care due to a lack of supervision. We have found that the complaint was unsubstantiated. While the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview was conducted. The report was read and reviewed with the director. A copy of the report and their appeal rights (LIC 9058) will be emailed to Director with a Read Receipt requested to acknowledge report was received. Director was asked to respond to email by copying and pasting “I have read and received the Investigation Report, I acknowledge receipt.” Investigation Report LIC 9099 will also be mailed if those options are not available. First level appeals should be sent to the regional manager to the address listed above. All appeals must be in writing and received by the licensing office within 15 business days. The first level appeal is to regional manager.

Copies of LIC 811 confidential names list dated 1/21/21 was provided

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

LIC9099 (FAS) - (06/04)

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