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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270291
Report Date: 06/07/2023
Date Signed: 06/07/2023 12:47:34 PM


Document Has Been Signed on 06/07/2023 12:47 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:SOUTH COAST YMCA-OAKGROVEFACILITY NUMBER:
304270291
ADMINISTRATOR:LORI SILVAFACILITY TYPE:
840
ADDRESS:22705 SANBORNTELEPHONE:
(949) 360-1427
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY:180CENSUS: 72DATE:
06/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Charmaine CrutchfieldTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) A Bootorabi conducted an unannounced case management incident inspection in response to a self-reported Unusual Incident dated 05/01/2023. LPA met with Director Charmaine Crutchfield. LPA toured the facility 3 of 3 rooms and observed 72 School Age Children with 7 staff.

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. During the visit, it was determined the facility is operating within its licensed capacity and within compliance with staffing ratios.

On 05/01/2023 a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a parent reported to the facility Inappropriate Behavior by Child #2 (C2), but no specific dates or times of when the incident/s occurred.

On 05/04/2023 LPA interviewed 5 staff (S1-S5) that work at the site and have worked or currently work with Child #1 (C1), and (C2). S1, and S2, stated they have never witnessed any inappropriate behavior between C1 & C2. S1 and S4 stated that no previous incidents were reported by C1. The YMCA supervision policy was discussed during staff interviews S1- S4, and it was mentioned that teachers conduct 15 min head counts of the children in care throughout the day for supervision purposes, staff are asked to walk around and reframe from sitting in one location with their backs turned to children to ensure adequate supervision. The LPA received proof of 15 min checks conducted by teachers to verify the practice. The LPA observed staff on 05/04/2023 between 1:30 pm – 2:30 pm, LPA observed staff engaging and supervising children indoors and outdoors. The LPA observed walkie-talkies being used by staff to communicate with each other when children are leaving or joining an area of care. S4 stated that children are supervised outside the restroom and only one child is allowed to go in at a time.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SOUTH COAST YMCA-OAKGROVE
FACILITY NUMBER: 304270291
VISIT DATE: 06/07/2023
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LPA interviewed C#1-C#3 on 05/04/2023. C1 disclosed inappropriate behavior by C2, but LPA was unable to obtain further details, due to C1 not wanting to continue the interview. C#2 stated they play tag with C1 and no further disclosure was made. C3 made no disclosures.

The LPA interviewed the director to discuss the last supervision training conducted for staff and it was stated it was completed on different dates depending on when they are hired. A record review confirmed that the training was conducted for S1-S5 that were interviewed on 05/04/2023 and all staff working directly with the children as well. LPA obtain 8 out of 8 staff training certificates for CYD Safety & Supervision.

The LPA interviewed P1 and P2, and no specific dates, times, or locations for the allegation of inappropriate behavior was provided to LPA.

Based on LPA staff and children interviews and statements, it was revealed that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.



In the areas that were evaluated, no deficiencies were observed in the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was conducted with the director Charmaine Crutchfield. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and 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. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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