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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494851
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:50:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2023 and conducted by Evaluator Joe Katrdzhyan
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20231128093132
FACILITY NAME:BURBANK YMCA CHILDRENS CENTER PRESCHOOLFACILITY NUMBER:
197494851
ADMINISTRATOR:ANGELA BUCKFACILITY TYPE:
850
ADDRESS:3401 SCOTT RDTELEPHONE:
(818) 729-1650
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:146CENSUS: 23DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director / Dierik GonzalezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision, resulting in child gone missing for an extended period of time.
INVESTIGATION FINDINGS:
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On 1/11/24, at 1:45AM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced visit to this facility to deliver findings on the above-mentioned allegation of “Staff did not provide adequate supervision, resulting in child gone missing for an extended period of time”. Upon arrival, LPA met with Director / Dierik Gonzalez, who guided LPA on a tour of the facility. There were 23 children with 4 staff observed present. LPA explained the purpose of today’s visit.

During the course of the investigation, interviews were conducted, pictures/videos were obtained and copies of Children / Staff Rosters were obtained and reviewed.

Per Reporting Party, on 10/31/23, at 4:45PM, the mother of Child 1 arrived at the big play yard to pick up Child 1 from the program and realized that Child 1 was missing. The teachers stated that prior to the mother’s arrival, they did a head count and Child 1 was observed playing at the big play yard. The teachers went looking for Child 1 in the playgrounds and classrooms and found Child 1 in room 17, playing on a
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 58-CC-20231128093132
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BURBANK YMCA CHILDRENS CENTER PRESCHOOL
FACILITY NUMBER: 197494851
VISIT DATE: 01/11/2024
NARRATIVE
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trampoline.

During the interview with the Director, it was disclosed that there was an incident involving Child 1 where Child 1 went missing. The incident occurred on 10/31/23, between 4:45PM– 4:50PM. The mother of Child 1 arrived to pick up Child 1 from the big play yard and upon asking the teachers about Child 1’s whereabouts, it was discovered that Child 1 was missing and not at the big play yard. There were 2 staff supervising the children in the big play yard at the time of the incident. Upon Staff 1 and 2 realizing that Child 1 was missing, they immediately notified Staff 3 (via telephone) and asked Staff 3 to assist in locating Child 1. After looking for Child 1 for approximately 7 minutes, Staff 3 found Child 1 in classroom 17, playing with toys with no staff supervision.

Statements obtained from staff corroborated with the statement obtained from the Director. Staff disclosed that prior to the mother’s arrival, Staff had conducted a head count of the children at the big play yard and Child 1 was accounted for. Staff disclosed that around the time of the incident, Staff 1 was changing a diaper on a child in the big play yard while Staff 2 had taken 3 other children to the bathroom. It is believed that this is when Child 1 must have wondered away from the big play yard. Per staff, Child 1 has behaviors of wondering and running away.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Dierik Gonzalez and Appeals Rights provided.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20231128093132
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK YMCA CHILDRENS CENTER PRESCHOOL
FACILITY NUMBER: 197494851
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2024
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The Director will review Title 22 Regulations Section 101229 on Responsibility for Providing Care and Supervision and develop a written Plan of Correction (POC) to ensure compliance. Written POC must be submitted to CCL by the POC due date.
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This requirement was not met as evidenced by interviews conducted and disclosures made indicating that child #1 went missing from the big play yard due to lack of supervision and was found in a classroom alone, with no staff supervision. This poses an immediate health, safety, and 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: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
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