300611755-7-19-2021-06-CC-RLOZ-C5APHQ-20210726112016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300611755
Report Date: 07/19/2021
Date Signed: 07/19/2021 03:13:22 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
05/14/2021 and conducted by Evaluator Ryan Joseph Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20210514082559

FACILITY NAME:	CAPISTRANO BEACH CITIES YMCA- PALISADES		FACILITY NUMBER:	300611755
ADMINISTRATOR:	FAULS-RIVAS, TYLER		FACILITY TYPE:	840
ADDRESS:	26462 VIA SACRAMENTO		TELEPHONE:	(949) 496-1627
CITY:	CAPISTRANO BEACH	STATE: CA	ZIP CODE:	92624
CAPACITY:	90	CENSUS: 16	DATE:	07/19/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tyler Fauls-Rivas (Director)		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Lack of supervision resulting in day care children engaging in inappropriate behavior.

INVESTIGATION FINDINGS:

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On 07/19/21 Licensing Program Analysts (LPAs) Ryan Chan and Lou Vanzant conducted an unannounced complaint investigation to deliver the finding to the allegation stated above. LPAs met with Director Tyler Fauls-Rivas who guided LPAs on a tour of the facility. Census was taken, there were a total of 16 school-aged children with 3 staff at the facility. 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.

On 05/14/21 the Orange County Child Care Office received a complaint alleging there was a lack of supervision resulting in day care children engaging in inappropriate behavior. Reporting party (RP) states staff were allowing the kids to hit each other with foam noodles while they are playing tag.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph Chan	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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-20210514082559

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: 07/19/2021

NARRATIVE

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During the course of the investigation, LPA Chan conducted interviews on 05/20/21, 05/21/21, 06/25/21, and 07/12/21 with the RP, subject child, 3 staff, 6 children, and 6 parents. LPA Chan also reviewed children’s roster, staff roster, and sign in/ sign out sheets for children and staff. It was discovered that the date of the incident was 05/12/21 not 05/13/21 as initially reported, 05/12/21 date was confirmed with RP.

This facility allows children the use of foam noodles to play a game of freeze tag. 6 of 6 children stated they were given instructions at the beginning of the game to only use the noodles to tag another person by lightly tapping, no hitting or swinging. One foam noodle is used to freeze a player and another foam noodle used to unfreeze. There are only 2 foam noodles used during the game. Facility director states foam noodles are used for this game to promote social distancing, so children are not touching each other due to COVID 19 concerns. During the interview, subject child stated C2 (see confidential names list dated 07/19/21) and subject child were both attacked by C1 (see confidential names list dated 07/19/21) and did not know what provoked C1. Subject child stated C1 had one foam noodle and C2 had the other foam noodle. Subject child stated S2 (see confidential names list dated 07/19/21) was there and saw it happen but did not intervene when C1 hit subject child. Subject child stated S1 (see confidential names list dated 07/19/21) took the foam noodles away after this incident. Subject child states children were given instruction on how the noodles should be used before the game, but instructions were not followed. Subject child also stated S1 and S2 did not talk to the children about their behaviors.

Children interviewed stated staff were always watching them. LPA interviewed children and asked if any children were hurt by the foam noodles, 3 of 6 children stated they have never seen another child get hurt by the foam noodles, 2 of 6 children stated the ones who get hurt were being “dramatic”. 1 of 6 children stated the foam noodles didn’t hurt but were bothersome. The one child that was bothered by the foam noodles was C1. C1 states subject child and C2 were hitting C1, C1 told them to stop and they did. C1 states C2 and subject child told S2 that C1 was hitting them which C1 denied stating C1 did not have the foam noodles, subject child and C2 had the foam noodles. C1 states S2 reminded the children the proper use of the foam noodles which were instructions given to the children before staff allowed children to use the foam noodles. Children interviewed stated they themselves never got hurt playing with the foam noodles.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph Chan	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20210514082559

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: 07/19/2021

NARRATIVE

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LPA interviewed staff who stated S2 oversaw the children in this group at the time of the incident. Records reviewed indicate there were 6 school aged children under S2’s supervision that day. S2 states children were given instructions before the game on the proper use of the foam noodles: no slashing, hitting, whipping, or pulling with the foam noodles, use the foam noodles only to tag. During the game, S2 states C1 told subject child not to hit which is when subject child got frustrated and responded by hitting C1. S2 saw the incident and ended the game and states children and staff discussed the incident as a group. S2 stated he was the only teacher with this group of children at the time of the incident.

Parents interviewed did not disclose any concerns with the care and supervision provided by staff. Parents were happy and stated their children were happy. Parents stated they would recommend this facility to another family.

Based on interviews conducted on 05/20/21, 05/21/21, 06/25/21, and 07/12/21 with the RP, subject child, 3 staff, 6 children, and 6 parents and also records reviewed, there was not enough evidence to determine if there was a lack of supervision resulting in day care children engaging in inappropriate behavior. Although 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, therefore the allegation is unsubstantiated.

An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights (LIC 9058) were discussed and a copy of the Appeal Rights was provided, their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A Notice of Site Visit was provided. The director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph Chan	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC9099 (FAS) - (06/04)

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