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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330909012
Report Date: 04/28/2022
Date Signed: 04/28/2022 11:42:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2022 and conducted by Evaluator Karrene Phillips
COMPLAINT CONTROL NUMBER: 09-CC-20220104101824
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: 0DATE:
04/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Art Cabrera, Program DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Personal Rights: Staff inappropriately handled child in care
INVESTIGATION FINDINGS:
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On April 28, 2022, Licensing Program Analyst (LPA) Kay Phillips arrived at Corona-Norco Family YMCA to conclude the investigation regarding the above allegation. LPA toured the facility and census was taken During the investigation interviews were conducted with pertinent parties and documentation was collected.

On January 4, 2022, a complaint was received alleging the facility was violating children's personal rights. The complaint stated a staff member inappropriately handled a child in care. Pertinent parties admitted that a staff memeber physically removed a child from another staff member's lap. It was reported the removal was not forceful in nature; however, the child did not want to be touched. During the inspection, the Program Director provided a copy of the video documenting the incident. From observation of the video, the staff member was observed cuffing the child up under their arm and removing them from the other's staff memeber's lap. It did not appear to be forceful nor did the child cry or express any emotion of hurt. The child was not in imminent danger to warrant the staff member's response. The Director was informed of children's rights, which states that children must be free from unusual punishment, infliction of pain, humilitation and intimidation.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene PhillipsTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 09-CC-20220104101824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 04/28/2022
NARRATIVE
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Based on all the information obtained from pertinent parties, documentation, records review during inspection, the Department has determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

See LIC 9099-D for deficiencies.

Exit interview was conducted with Art Cabrera, Program Director. A copy of this report, Notice of Site Visit, and Appeal Rights were provided. The Notice of Site Visit provided must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. A copy of this report must be made available to the public for three years upon request.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene PhillipsTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20220104101824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion...or other actions of a punitive nature....

This requirement was not met as evidenced by:
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The director will conduct an in-service training on the personal rights of children while in care at the facility. Director will submit the agenda of what is discussed and the staff member sign in sheet to the LPA by the POC date.
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The staff member was observed cuffing the child up under them arm and removing their from the other's staff memeber's lap. It did not appear to be forceful nor did the child cry or express any emotion of hurt. which poses a potential health, safety, or personal rights risk to persons in care.
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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: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3