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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570305378
Report Date: 06/08/2023
Date Signed: 06/08/2023 10:06:36 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/18/2023 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230418151721
FACILITY NAME:YMCA OF SUPERIOR CALIFORNIA - YOLO PRESCHOOLFACILITY NUMBER:
570305378
ADMINISTRATOR:KATIE GUINANFACILITY TYPE:
850
ADDRESS:1300 COLLEGE STREETTELEPHONE:
(530) 662-1086
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:69CENSUS: 23DATE:
06/08/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:director, Cathlean RipleyTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Facility did not immediately notify child's authorized representative of an injury
Staff changed a child on a cement floor outside.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lauren Scott met with Director, Cathlean Ripley to deliver the findings of the complaint investigation regarding the above allegations.
During the course of the investigation, LPA Scott conducted interviews, and obtained information pertaining to allegations. It was alleged that staff changed the child’s diaper in a way that did not protect the child’s personal rights. It was also alleged that parents were not immediately notified of a child’s head injury. Through interviews, it was revealed that a child's diaper was changed outside on the cement without proper diapering procedures in place. It was also revelaed through injury reports and interviews that injuries more than a minor cut or scratch, were not reported to parents at time of injury.

Based on the interviews and review of records that revealed facility violated the child’s personal rights as well as failed reporting requirements to parents. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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 53-CC-20230418151721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - YOLO PRESCHOOL
FACILITY NUMBER: 570305378
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2023
Section Cited
CCR
101226(a)
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(a)The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch.

This requirement was not met as evidenced by:
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Facility will conduct a staff meeting with all staff regarding reporting requirements to parents of injuries that occur that are more significant than a minor cut or scratch. This includes timeline of reporting to parents. Facility will submit meeting notes with staff signatures to LPA by 7/7/23
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Facility failed to report head injuries to parents at time injury occurred.

This poses a potential health, safety, or personal rights risk to children in care.
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Type B
07/07/2023
Section Cited
CCR
101223(a)(2)
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(a)The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:
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Facility will conduct a staff meeting with all staff regarding the proper way to change children's diaper in each area of the facility, including while outside. Facility will submit meeting notes with staff signatures to LPA by 7/7/23
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Facility did not change a child's diaper with proper furnishings or allow privacy

This poses a potential health, safety, or personal rights risk to 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3