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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843588
Report Date: 08/29/2023
Date Signed: 08/29/2023 02:07:48 PM


Document Has Been Signed on 08/29/2023 02:07 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:YMCA YOUTH CENTER AT RIVER ROAD PARKFACILITY NUMBER:
334843588
ADMINISTRATOR:BEATRIZ DE CAROFACILITY TYPE:
830
ADDRESS:1100 RIVER ROADTELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:24CENSUS: 17DATE:
08/29/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Leticia Hernandez, Site SupervisorTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts(LPAs) Elyse Jones and Blanca arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During file review LPAs were unable to review a current Mandated Reporter certificate for S1 and S7. LPAs were also unable to verify require immunizations for S3.

See LIC 809-D for deficiency cited.


Exit interview conducted and report was reviewed with Leticia Hernandez, Site Supervisor. A Notice of Site Visit was given and must remain posted on, or immediately adjacent to the interior of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023
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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Document Has Been Signed on 08/29/2023 02:07 PM - It Cannot Be Edited

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: YMCA YOUTH CENTER AT RIVER ROAD PARK
FACILITY NUMBER: 334843588

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2023
Section Cited
HSC
1596.7995(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles...

This requirement is not met as evidenced by:
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Site Supervisor agrees to obtain DTap immunizations for S3 and submit to the Department on or by POC due date.
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Based on the record review, the Licensee did not meet the above regulation which poses a potential Health, Safety & Personal Rights risk to the children in care. LPA was unable to review DTap immunization records for S3.
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Type B
09/05/2023
Section Cited
HSC1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete
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 certificate for S2 and S7.

Site Supervisor agrees to have S2 and S7
complete Mandated Reporter Training and will submit a certificate to the Department on or before POC due date.
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renewal mandated reporter training every two years...
Based on the record review, the Licensee did not meet the above regulation which poses a potential Health, Safety & Personal Rights risk to the children in care. LPA was unable to review a current Mandated Reporter
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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: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2