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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803473
Report Date: 02/05/2020
Date Signed: 02/05/2020 10:16:37 AM

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:DESERT YMCA/JEAN M. BENSON CDCFACILITY NUMBER:
334803473
ADMINISTRATOR:CRISTY HARSHAWFACILITY TYPE:
850
ADDRESS:75-433 ORANGE BLOSSOMTELEPHONE:
(760) 836-3336
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:101CENSUS: 54DATE:
02/05/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:CRISTY HARSHAWTIME COMPLETED:
10:25 AM
NARRATIVE
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 01/28/2020. It indicates that on Friday, 01/24/2020 at about 5:00pm Staff 1 was observed inappropriately handling Child 1. Child 1 was seen exiting the fox’s classroom and was brought back into the classroom brusquely by Staff 1. On 01/27/2020, Staff 1 was then terminated based on the incident and behavior.

During the visit today, Licensing Program Analyst (LPA), John Huynh reviewed facility records, viewed and obtained the video footage captured on 01/24/2020 and conducted interviews. Based on the information gathered, the following violation has been identified:

101223 (a)(3) Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility staff.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: John HuynhTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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: DESERT YMCA/JEAN M. BENSON CDC
FACILITY NUMBER: 334803473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2020
Section Cited

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Personal Rights. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature. This requirement was not met as evidenced by: On 01/24/2020, Staff 1 was observed inappropriately handling
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Child 1. Child 1 was seen exiting the fox’s classroom and was brought back into the classroom brusquely by Staff 1. This poses an immediate risk to the Health and Safety of children 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) 320-2023
LICENSING EVALUATOR NAME: John HuynhTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2020
LIC809 (FAS) - (06/04)
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