304270291-12-17-2019-06-CC-RLOZ-BKSSKF-20200113125641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304270291
Report Date: 12/17/2019
Date Signed: 12/17/2019 05:35:32 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
10/02/2019 and conducted by Evaluator Gesine Connolly

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20191002162124

FACILITY NAME:	SOUTH COAST YMCA-OAKGROVE		FACILITY NUMBER:	304270291
ADMINISTRATOR:	LORI SILVA		FACILITY TYPE:	840
ADDRESS:	22705 SANBORN		TELEPHONE:	(949) 360-1427
CITY:	ALISO VIEJO	STATE: CA	ZIP CODE:	92656
CAPACITY:	180	CENSUS: 42	DATE:	12/17/2019
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Program Director Pam Kowalski		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Staff restrained day-care child.

INVESTIGATION FINDINGS:

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The purpose of this inspection is to complete a complaint investigation of the facility. On 10/02/19 a complaint was filed with the licensing office alleging staff restrained a day care child.
During today's complaint inspection Licensing Program Analyst (LPA) Connolly met with assistant director Jilliam Foret who guided the LPA on a tour of the facility. Director Lori Silva was not present. There were 42 school age children, grades one, two and three, in room Y-1 with four staff including the assistant director. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.

On 10/14/19 Licensing Program Analyst (LPA) Connolly made an initial complaint inspection. During the initial inspection LPA Connolly interviewed the director and three additional staff. At that time the director provided copies of Parent Communication Forms for the months August and September 2019.
Continued on page two

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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-20191002162124

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: SOUTH COAST YMCA-OAKGROVE	FACILITY NUMBER: 304270291
	VISIT DATE: 12/17/2019

NARRATIVE

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During today's inspection four children interviews were conducted. None of the children interviewed disclosed any evidence or information regarding observing any incident where staff restrained a child in care.
It has been determined that the subject child no longer attends YMCA-Oakgrove and there has been no response in the attempt to reach the subject child. The LPA is continuing to obtain a police report after several attempts to secure.

During the initial complaint inspection LPA Connolly interviewed 4 staff. None of the 4 staff interviewed disclosed witnessing any staff restraining a child in care . One family member, during an interview, stated confidence in the in the care and supervision provided by staff. Review of the documentation provided during the initial complaint inspection shows staff followed YMCA protocol.

Program Director Pam Kowalski came to Y-1 to be available for the exit interview. During the exit interview when the licensing report was reviewed and discussed the program director was informed that 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.

No deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the visit.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

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

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC9099 (FAS) - (06/04)

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