573601607-9-26-2019-53-CC-SOGO-BH7TSX-20191022145950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 573601607
Report Date: 09/26/2019
Date Signed: 09/26/2019 03:15:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2019 and conducted by Evaluator Joleen Kenney

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20190807084957

FACILITY NAME:	YMCA OF THE EAST BAY-WOODLAND		FACILITY NUMBER:	573601607
ADMINISTRATOR:	ROBLES, SOCORRO		FACILITY TYPE:	850
ADDRESS:	1285 LEMEN AVE		TELEPHONE:	(530) 668-9622
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95776
CAPACITY:	75	CENSUS: 55	DATE:	09/26/2019
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Sandra Torres, Center Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff grabbed a child that resulted in bruising.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Chayntel Hunter and Joleen Kenney conducted a follow up complaint inspection to deliver the findings for the above allegation. It was alleged that staff grabbed a child that resulted in bruising. During the investigation, LPA Hunter conducted interviews with staff, parents and children and reviewed records. It was revealed by a child (C1) to their parent and two staff members that staff (S1) grabbed their arm. It was observed that bruises were on the child’s arm and pictures were also taken that same day and provided for review. Although S1 denied grabbing the child’s arm, S1 stated that the child was redirected by taking the child’s hand and moved to another area in the classroom. Based on the information obtained during the investigation the preponderance of evidence standard has been met, therefore the above allegation is substantiated.

The following Type A deficiency was cited on the subsequent page. California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 53-CC-20190807084957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: YMCA OF THE EAST BAY-WOODLAND	FACILITY NUMBER: 573601607
	VISIT DATE: 09/26/2019

NARRATIVE

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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 is available on the website. If the LIC 9224 is not used, the licensee shall prepare a statement indicating the documents have been provided. Licensee shall require the parent/guardian to sign and date the statement and shall keep the signed statement as receipt. Verification of receipt shall be kept in each child's file at the facility.

Exit interview conducted. Appeal Rights were provided. Notice of Site Visit was provided and posted.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 53-CC-20190807084957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: YMCA OF THE EAST BAY-WOODLAND	FACILITY NUMBER: 573601607
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 09/27/2019 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	The licensee shall ensure that each child is accorded the following 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 is not met as evidenced by:	1 2 3 4 5 6 7	The Center Director stated that training will be conducted with all staff regarding properly redirecting a child with behaviors with safe techniques. The Center Director will submit a scheduled training date to LPA Hunter by the plan of correction date of 9/27/2019.
	8 9 10 11 12 13 14	During the investigation it was revealed that a staff (S1) grabbed a child that resulted in bruising on the child's arm. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen Kenney	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3