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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334820558
Report Date: 09/05/2023
Date Signed: 09/05/2023 04:06:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/03/2023 and conducted by Evaluator Elyse Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230703165126
FACILITY NAME:CORONA-NORCO FAMILY YMCA-YOUTH CENTER AT HARADAFACILITY NUMBER:
334820558
ADMINISTRATOR:BERTHA ESTRADAFACILITY TYPE:
840
ADDRESS:12884 OAKDALE STREETTELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:70CENSUS: 42DATE:
09/05/2023
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Bertha Estrada, Site Supervisor TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in children engaging in inappropriate behavior.
INVESTIGATION FINDINGS:
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On September 5, 2023, Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conclude the investigation regarding the above allegations. LPA met with Bertha Estrada, Site Supervisor, conducted a tour of the facility, and took census.

On July 3, 2023, a complaint was received alleging staff did not provide adequate supervision resulting in children engaging in inappropriate behavior. It was specifically alleged a child was asked several times to participate in inappropriate behavior with another child. During the interviews, pertinent parties confirmed that the alleged incident did occur. It was also disclosed that an additional incident occurred in March 2023 but was not reported or discussed with the subject child’s Authorized Representatives. While the investigation was open, a third incident was self-reported by the facility involving the same child engaging in inappropriate behavior. All reported incidents occurred over the spam of four months with different children.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
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 09-CC-20230703165126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CORONA-NORCO FAMILY YMCA-YOUTH CENTER AT HARADA
FACILITY NUMBER: 334820558
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2023
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (1)To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidenced by:
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Site Supervisor agrees to conduct a staff training with on but not limited to Personal Rights. Training agenda must be submitted by POC due date on 9-6-2023. Once training is completed a sign in sheet must be submitted to the Department with 24 hours.
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Based on interview and record review, the Licensee did not meet the above regulation which poses an immediate Health, Safety & Personal Rights risk to the children in care. Staff neglected to ensure children were being accorded dignity in his/her personal relationships with staff and other persons.
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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: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230703165126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CORONA-NORCO FAMILY YMCA-YOUTH CENTER AT HARADA
FACILITY NUMBER: 334820558
VISIT DATE: 09/05/2023
NARRATIVE
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Based on documents received and information obtained during interviews conducted, the preponderance of evidence standard has met. The above allegation is SUBSTANTIATED.

See LIC 9099-D for the deficiencies cited.

Type A Deficiency was given and must remain posted on, or immediately adjacent to the interior of the main door for 30 days. Appeal Rights discussed and given to facility representative, along with a copy of this
report and LIC 9224 was given to the licensee or facility representative.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Bertha Estrada, Site Supervisor.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3