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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300611755
Report Date: 01/21/2021
Date Signed: 04/14/2021 04:45:59 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
08/28/2020 and conducted by Evaluator Sherene Hawkins
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20200828110918
FACILITY NAME:CAPISTRANO BEACH CITIES YMCA- PALISADESFACILITY NUMBER:
300611755
ADMINISTRATOR:FITZPATRICK, CAROLEFACILITY TYPE:
840
ADDRESS:26462 VIA SACRAMENTOTELEPHONE:
(949) 496-1627
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:90CENSUS: 19DATE:
01/21/2021
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Tyler Fauls-Rivas.TIME COMPLETED:
02:43 PM
ALLEGATION(S):
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Staff making inappropriate comments towards day care child
INVESTIGATION FINDINGS:
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***This is an amended version of the original report created on 1/21/21.
Tele-Inspection- COVID-19 State of Emergency
At 1:58 PM Licensing Program Analyst (LPA) Hawkins contacted the facility to conduct a tele-visit and director asked to follow up in 30 minutes due to children transitioninig.
At 2:20 PM LPA Hawkins conducted a follow up investigation regarding a complaint of a personal rights allegation which was initiated on 09/04/20 by LPA Connolly. 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 08/28/20 the Department received complaint alleging that staff made inappropriate comments towards a day care child.
**continued on page 2**
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 06-CC-20200828110918
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
***This is an amended version of the original report created on 1/21/21.
During the investigation, LPA interviewed 5 staff, 8 parents, 10 children and reviewed facility records. It was reported that staff talked to a day care child in a demeaning way and called the child a “tattle teller” after child reported an incident to staff.

Staff #3 (S3) reported witnessing Staff 4 (S4) speaking in a demeaning way to C5. S3 reported asking S4 not to speak to the children that way, then checked C5 to ensure the child was okay. S3 did not report this incident to management. S3 stated that days later S4 was laid off and no longer works for the agency. Other staff interviewed were not aware of the incident and have never witnessed children being spoken to rudely by staff. S4 denies that any staff including herself has ever treated or spoke to the children in a demeaning way. Director added that there was never any incident documented regarding S4 being disciplined.

Children interviewed stated that the staff treats and speaks to them kindly, and the children did not report any negative experiences. One child initially reported being spoken to in a demeaning way, however at a later date during the investigation the child declined to be interviewed further. Parents interviewed had no concerns with the care of the children.

This agency has investigated the complaint alleging that staff made inappropriate comments towards a day care child. 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 HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20200828110918
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
CCR
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***This is an amended version of the original report created on 1/21/21***
There was no citations issued as a result of this investigation.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/28/2020 and conducted by Evaluator Sherene Hawkins
COMPLAINT CONTROL NUMBER: 06-CC-20200828110918

FACILITY NAME:CAPISTRANO BEACH CITIES YMCA- PALISADESFACILITY NUMBER:
300611755
ADMINISTRATOR:FITZPATRICK, CAROLEFACILITY TYPE:
840
ADDRESS:26462 VIA SACRAMENTOTELEPHONE:
(949) 496-1627
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:90CENSUS: 19DATE:
01/21/2021
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Tyler Fauls-Rivas.TIME COMPLETED:
02:43 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulting in inappropriate behaviors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Tele-Inspection- COVID-19 State of Emergency
Licensing Program Analyst (LPA) S. Hawkins conducted a follow up investigation regarding a complaint of a personal rights allegation which was initiated on 09/04/20 by LPA Connolly. 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 08/28/20 the Department received a complaint of lack of supervision resulting in inappropriate behaviors between childcare children. It was reported that a day care child walked into the bathroom while another child was present and preceded to shake and touch the other child already present in the bathroom on the child’s arms and sides. ***continued on page 2***
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (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)
Page: 4 of 5
Control Number 06-CC-20200828110918
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 5 staff, 8 parents, 10 children and reviewed facility records. Staff interviewed reported that they were not aware of any similar incident occurring in the restroom and added that children are always supervised during restroom time. Staff reported the procedure is to allow one child to use the bathroom at a time unless there is an emergency then it is allowed. Staff added that (C10) has been known to follow children into the bathroom while talking with them, however staff redirects the child immediately. S3 reports of an incident involving (C10) and (C5) entering the bathroom together and (C10) was directed immediately to exit. Children interviewed reported that only one person at a time is allowed in the bathroom. Several attempts were made to interview additional children associated to the complaint; however, attempts were not successful. Parents interviewed had no concerns with the care and supervision of the children.

This agency has investigated the complaint alleging a lack of supervision resulting in inappropriate behaviors between childcare children. 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.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (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)
Page: 5 of 5