334804258-9-3-2025-09-CC-ANOE-DLTP3E-20250924105723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334804258
Report Date: 09/03/2025
Date Signed: 09/03/2025 05:30:46 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2025 and conducted by Evaluator Susan Brewer

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20250814102922

FACILITY NAME:	CORONA NORCO YMCA YOUTH CENTER AT HOME GARDENS		FACILITY NUMBER:	334804258
ADMINISTRATOR:	LETICIA HERNANDEZ		FACILITY TYPE:	840
ADDRESS:	13550 TOLTEN AVENUE		TELEPHONE:	(951) 278-9680
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	36	CENSUS: 26	DATE:	09/03/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee Leticia Hernandez		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Licensee did not properly report incident

INVESTIGATION FINDINGS:

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On the above date and time Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to continue an complaint investigation into the above allegation and to deliver findings. The LPA met with Director Leticia Hernandez. A census was conducted of 26 children supervised by 4 staff.

The investigation was initiated on 08/21/2025. The LPA Susan Brewer met with the director to discuss the allegation regarding Reporting Requirements. During the initial investigation the LPA made observations, reviewed records, and conducted interviews and more time was needed to complete the investigation.

On today’s date, the LPA met with the director to continue the investigation, reviewed additional records and conducted interviews.

See LIC9099C Page 2.

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

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 09-CC-20250814102922

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CORONA NORCO YMCA YOUTH CENTER AT HOME GARDENS	FACILITY NUMBER: 334804258
	VISIT DATE: 09/03/2025

NARRATIVE

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LIC9099C Page 2

It was alleged that the licensee did not properly report an incident, when a subject child sustained an injury during daycare hours, which required medical attention. The LPA conducted observations, reviewed records and conducted interviews with pertinent parties which revealed: On 08/26/2024 a subject child sustained a head injury above the eye which resulted in a bump and bruising. Following the incident, the licensee reported the incident to authorized representatives as required. It was also reported that the authorized representatives sought medical attention for the subject child due to developed swelling and bruising. The subject child returned to daycare shortly following incident.

However, further review of facility records indicate the licensee was unable to provide proof that the 08/26/2024 incident involving the subject child, was not reported to community care licensing as required. By admission, the director stated they completed the Unusual Incident Report and submitted the report to their administrative department for review, prior to formal submission to the department. Therefore, it was determined that the licensee did not submit the report to Community Care Licensing, regarding the unusual incident that occurred on 08/26/2024 by telephone or fax to the department by the next business day, as required through Title 22 regulation, section 101212(d) Reporting Requirements.

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 that the licensee did not properly report incident, is found to be SUBSTANTIATED.

A deficiency was issued on the LIC 9099D for the Title 22, California Code of Regulations, 101212(d) Reporting Requirements,

No civil Penalties were issued.

An exit interview was conducted to review the report, and a copy of this report was left with Director Leticia Hernandez.

A Notice of Site Visit was provided to Director Leticia Hernandez. The LPA observed the Notice of Site Visit form was posted by staff.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 09-CC-20250814102922

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CORONA NORCO YMCA YOUTH CENTER AT HOME GARDENS	FACILITY NUMBER: 334804258
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/03/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/30/2025 Section Cited CCR 101212(d)	1 2 3 4 5 6 7	101212(d) Reporting requirements…the child care center of any of the events specified in (d)(1)…a report shall be made to the Department by telephone or fax within the Department's next working day & during its normal business hours… as specified in (d)(2)…following the occurrence of such event.	1 2 3 4 5 6 7	The licensee agrees to ensure compliance with all Title 22 Regulations to include Section 101212 Reporting requirements, 101212(d)(1) and 101212(d)(2) and submit a written statement of understanding to the department regarding the regulation, including procedures for future required reporting.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Based upon LPA record review and interview, the licensee was unable to prove proof of self-reporting an unusual incident occurring on 08/26/2024, which is a potential health and safety risk to children in care.	8 9 10 11 12 13 14	In addition, the licensee agrees to submit the plan by fax, mail or e-mail.
	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.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025

LIC9099 (FAS) - (06/04)

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