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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909012
Report Date: 01/10/2022
Date Signed: 01/10/2022 04:42:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CORONA-NORCO FAMILY YMCAFACILITY NUMBER:
330909012
ADMINISTRATOR:ART CABRERAFACILITY TYPE:
840
ADDRESS:1331 RIVER ROADTELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:70CENSUS: 17DATE:
01/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Tammy Ellis (Associate Executive Director) & Art Cabrera (Director)TIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kay Phillips and Kim Leung, arrived at the facility to conduct an inspection. During the course of the inspection while taking census, it was observed that Staff 1 was supervising 17 children with no assistance. Facility was operating out of ratio while Staff 2 was outside of the activity room.

See LIC 809-D for deficiency cited per California Code of Regulations, Title 22, Division 12.

An exit interview was conducted with the Associate Executive Director, Tammy Ellis, and the Director, Art Cabrera. A Notice of Site visit was issued and must be posted or 30 days. A copy of this report was provided to the facility. The director was provided with a copy of the appeal rights (LIC9058 12/2015) and the signature on this report acknowledges receipt of those rights. A COPY OF ALL TYPE A DEFICIENCIES (LIC809D) CITED DURING THIS INSPECTION MUST BE POSTED FOR 30 DAYS. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene PhillipsTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CORONA-NORCO FAMILY YMCA
FACILITY NUMBER: 330909012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2022
Section Cited

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101516.5 (b)(1) Teacher-Child Ration. A teacher shall supervise no more than 14 chldren or with an aid a maximum of 28 children. This requirement was not met as evidenced by: the facility was observed to be out of ratio with one staff supervising 17 children without assistance while the second staff member was outside of the activity room.
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This is an immediate health and safety risk for the children in care.
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Director also agrees to provide in service training on teacher-child ratio to meet the needs of the children they are assigned to each staff; to provide CCL with sign in sheet/ agenda of topic and date and time of training by 01/11/2022.

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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: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene PhillipsTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2022
LIC809 (FAS) - (06/04)
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