304270419-6-7-2023-06-CC-RMCN-CSL224-20230607170006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270419
Report Date: 06/07/2023
Date Signed: 06/07/2023 05:00:11 PM

Document Has Been Signed on 06/07/2023 05:00 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:	YMCA PETERSON PROGRAM CENTER		FACILITY NUMBER:	304270419
ADMINISTRATOR:	KRISTA ORPITELLI		FACILITY TYPE:	840
ADDRESS:	20661 FARNSWORTH LANE		TELEPHONE:	(714) 536-0068
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	127	CENSUS: 26	DATE:	06/07/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Director Jordyn Nelson		TIME COMPLETED:	05:15 PM

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Licensing Program Analyst (LPA) Romy Castanon conducted a case management inspection to follow up on a self-reported unusual incident on 05/30/2023. Director Megan Sabedir Taylor from sister school reported incident verbally on 05/31/2023. Director Jordyn Nelson was absent on the date of the incident but submitted LIC624 form to the Orange County Regional Licensing Office on 06/05/2023.

LPA met with Director Jordyn Nelson. Upon LPA’s arrival in Room P5, there were no children. Children began arriving at 2:45pm. There was a total of 26 children and 2 staff members on the playground. 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.

The unusual incident report written by the Director stated at 3:15pm, Staff #1 (S1) and Staff #2 (S2) were caring for 28 children total, each class had 14 children. S1 and S2 classes were playing on the playground when Child #1 (C1) pulled their pants down and exposed themselves to four of their peers.

During today's visit, LPA spoke with Director for further detailed information not found on UIR. LPA also interviewed 2 staff and 3 out of 5 children. The snack tables are adjacent to the playground so when the children are done eating, they can transition to their organized games. S1 was standing at the left corner between the playground and snack tables. There were between 6-10 children eating at the snack tables. S2 was cleaning up the snack area and positioned themselves opposite corner from S1. S1 and S2 both stated children came to them detailing the incident. Two children stated they observed their underwear only and 3 children stated they observed exposed body parts. All children stated it was for about 1-2 seconds. S1 spoke to all the children involved regarding inappropriate behavior. S1 and S1 conducted a read aloud activity for the students regarding body boundaries. S1 informed all parents of children involved verbally and they also signed a written “Parent Communication Form” regarding the incident.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M Castanon	TELEPHONE: (714) 743-8565
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

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: YMCA PETERSON PROGRAM CENTER	FACILITY NUMBER: 304270419
	VISIT DATE: 06/07/2023

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LPA reviewed training documentation regarding supervision provided at facility’s all staff monthly meeting to remind them of the facility’s supervision procedures. All staff members attended company wide Safety & Supervision training on 06/03/2023. Director has implemented a supervision policy that staff are to always be positioned opposite of each other. Director also plans to create a more structured transition period for all classrooms.

Based on LPA’s record review and interviews conducted, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Director Jordyn Nelson. Notice of Site Visit was posted during the inspection. 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. Director was provided a copy of their appeal rights LIC 9058 and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Romelia M Castanon	TELEPHONE: (714) 743-8565
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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