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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191608844
Report Date: 01/19/2023
Date Signed: 01/19/2023 08:21:26 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2022 and conducted by Evaluator Monique Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20221014110534
FACILITY NAME:YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITEFACILITY NUMBER:
191608844
ADMINISTRATOR:MAXINE CASEYFACILITY TYPE:
840
ADDRESS:5206 BRIERCRESTTELEPHONE:
(562) 925-6493
CITY:LAKEWWODSTATE: CAZIP CODE:
90713
CAPACITY:56CENSUS: 10DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Teacher, Janessa Smith TIME COMPLETED:
08:35 PM
ALLEGATION(S):
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Daycare child sustained an injury while in care.
INVESTIGATION FINDINGS:
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On January 19, 2023 at 7:30 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Teacher, Janessa Smith. The purpose of the inspection was to deliver the complaint investigation findings for the allegation noted above.

During the course of investigating the allegation, LPA conducted confidential interviews and obtained copies of pertinent documents. On October 17, 2022, LPA conducted a telephone interview with the Complainant/Reporting Party (RP) and obtained copies of pertinent documents via e-mail. On October 20, 2022, LPA conducted in-person interviews with three staff (S1, S2, and S3) and one child (C1). LPA attempted to conduct additional interviews with children (C2, C3, and C4) at the facility however, one child declined to speak with LPA and two of the children were not present. LPA also obtained copies of pertinent documents from the facility both in-person and via e-mail.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
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 7
Control Number 54-CC-20221014110534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 01/19/2023
NARRATIVE
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On January 4, 2023, LPA conducted telephone interviews with five parents and attempted to contact one additional parent as well as the RP. On January 19, 2023, LPA attempted to conduct interviews with two children (C3 and C4) at the facility; however, both children were not present.

Some of the documents obtained for review consisted of the Admission Agreement for C4, "Ouch" Report for C4, Identification and Emergency Information (LIC 700) for C4, Parent Handbook, Unusual Incident/Injury Report (LIC 624) for C4, and the Medical After Visit Summary for C4.

The 2022/2023 Registration Packet/Parent Handbook (YMCA Health Policies and Procedures) states that the program would take the following steps in the event that a child is injured at the program; (1) attempt to contact the parent, legal guardian, and/or emergency contact, (2) if the program cannot contact anyone, the program may do any or all the following: (2a.) call the paramedics/ambulance, (2b.) take, or have the child taken to, an emergency hospital-accompanied by a YMCA staff member-for diagnosis and/or treatment.

Based on the "Ouch" Report, LIC 624, Medical After Visit Summary Report, and confidential interviews, LPA determined the following: C4 tripped over another child that was picking up toys off of the floor while in the cafeteria; C4 sustained an injury due to the incident; staff were inside the cafeteria at the time of the incident but did not witness C4 fall; staff (S2) later noticed C4 holding their arm and tended to the child by asking pertinent questions related to the injury, provided an ice pack to C4 for the injury, and immediately notified the Director (S1). S1 contacted C4's parent after being notified of the injury, and the parent took the child to seek medical care.

Although the child sustained an injury at the facility, the information obtained revealed that staff took the proper measures to ensure that the child's parent was notified of the injury and the child was able to be medically evaluated for the injury. However, the LIC 624 that was submitted to the Department on 10/27/2022 stated that "a staff did not see (C4) fall but did notice (C4) grabbing (their) arm during snack time and asked what had occurred to (C4)." The confidential interviews confirmed that none of the staff visually observed when C4 fell. LPA also obtained a disclosure from a parent expressing concern regarding the supervision provided by the facility.

Based on the information obtained, there is a preponderance of the evidence to prove that the facility failed to provide adequate supervision per Title 22 regulations. Therefore, the allegation is substantiated.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 54-CC-20221014110534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 01/19/2023
NARRATIVE
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Deficiency was cited during today's inspection. Appeal rights were provided and discussed with the facility representative.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Teacher, Janessa Smith.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2022 and conducted by Evaluator Monique Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20221014110534

FACILITY NAME:YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITEFACILITY NUMBER:
191608844
ADMINISTRATOR:MAXINE CASEYFACILITY TYPE:
840
ADDRESS:5206 BRIERCRESTTELEPHONE:
(562) 925-6493
CITY:LAKEWWODSTATE: CAZIP CODE:
90713
CAPACITY:56CENSUS: 10DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH: Teacher, Janessa SmithTIME COMPLETED:
08:35 PM
ALLEGATION(S):
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Staff demonstrates inappropriate form of punishment.
Staff is mistreating a daycare child.
Staff encourages activities to cause harm to daycare children.
Staff behavior poses as a risk to the daycare children.
INVESTIGATION FINDINGS:
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On January 19, 2023 at 7:30 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Teacher, Janessa Smith. The purpose of the inspection was to deliver the complaint investigation findings for the allegations noted above.

During the course of investigating the allegations, LPA conducted confidential interviews and obtained copies of pertinent documents. On October 17, 2022, LPA conducted a telephone interview with the Complainant/Reporting Party (RP) and obtained copies of pertinent documents via e-mail. On October 20, 2022, LPA conducted in-person interviews with three staff (S1, S2, and S3) and one child (C1). LPA attempted to conduct additional interviews with children (C2, C3, and C4) at the facility however, one child declined to speak with LPA and two of the children were not present. LPA also obtained copies of pertinent documents from the facility both in-person and via e-mail.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 54-CC-20221014110534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 01/19/2023
NARRATIVE
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On January 4, 2023, LPA conducted telephone interviews with five parents and attempted to contact one additional parent as well as the RP. On January 19, 2023, LPA attempted to conduct interviews with two children (C3 and C4) at the facility; however, both children were not present.

Some of the documents obtained for review consisted of the Admission Agreements for C3 and C4, "Ouch" Report for C4, Behavioral Reports for C3, Identification and Emergency Information (LIC 700) for C3 and C4, Daily Activity Schedule for October, Parent Handbook, Unusual Incident/Injury Report (LIC 624) for C4, and the Medical After Visit Summary for C4.

The 2022/2023 Registration Packet/Parent Handbook (Incidental Medical Services Plan) states that the parent of a child with special needs may meet with the Director of the program and complete an "Individual Child Needs Assessment & Program Plan" to identify specific needs and strategies that may be used to help the child be successful in the program. Based on record review, C4 did not have an "Individual Child Needs Assessment & Program Plan" on file. The confidential interviews also revealed that staff treat the children fairly.

Based on record review, C4 has a signed Admission Agreement on file. The Admission Agreement states that the YMCA may terminate a child's enrollment for any of the following reasons: behavior that is continually disruptive or dangerous to others and/or self. Based on record review, C4 received behavioral notices on 10/03/22, 10/10/2022, and 10/13/2022. Each behavioral report was signed and dated by the child's parent/guardian. Based on interviews, the behavioral notices resulted in a temporary termination from the program. Based on the information obtained, staff took the proper measures to address a child's behavior that harmed other children in care and as a result, LPA also determined that the staff behavior did not pose as a risk to the daycare children.

On 10/20/2022, LPA observed the Daily Activity Schedule for October posted on the parent board that was located near the gate where children are picked up and dropped off for the program. The Daily Activity Schedule noted "Group Game" on Tuesday's and Thursday's from 4:05 pm to 4:25 pm. Group Game consists of "Head Toe Eraser 3&up, Sharks & Menos K-2nd, Four Square 3rd&up, and Kick Ball."
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 54-CC-20221014110534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
VISIT DATE: 01/19/2023
NARRATIVE
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Based on the confidential interviews, children are not forced but are encouraged to participate in group games. The interviews revealed that the group games are divided by grade levels and are considered age-appropriate. The interviews also revealed that children have the option to sit-out of any of the scheduled group games. Based on the interviews and observations, the children have other activities available to use in the event a child does not wish to participate in a particular activity. Based on the information obtained, staff did not violate the personal rights by encouraging activities that cause harm to children in care.

Based on the information obtained, there is not a preponderance of the evidence to prove that personal rights were violated. Therefore, the allegations are unsubstantiated. Appeal rights were provided and discussed with the facility representative.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Teacher, Janessa Smith.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 54-CC-20221014110534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: YMCA GLB - WEINGART-LAKEWOOD - GOMPERS SITE
FACILITY NUMBER: 191608844
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2023
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility of Providing Care and Supervision - No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Section 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
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The program will conduct an in-depth training on the responsibility for providing care and supervision as well as reviewing the previous oversights with all staff, including the Director and Program Manager for the facility.
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Based on interviews and record reviews, a child sustained an injury at the facility that was not visually observed by any staff which posed a potential health and safety risk to persons in care.
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The facility will submit to LPA via e-mail a sign-in sheet for the attendees and the presented training material by 02/20/2023.
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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: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7