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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843588
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:36:57 PM

Document Has Been Signed on 03/09/2022 01:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:YMCA YOUTH CENTER AT RIVER ROAD PARKFACILITY NUMBER:
334843588
ADMINISTRATOR:BEATRIZ DE CAROFACILITY TYPE:
830
ADDRESS:1100 RIVER ROADTELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
03/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Beatriz De Caro, DirectorTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts(LPAs) Elyse Jones and Blanca Ruiz-Silva arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the inspection LPAs conducted a tour of the facility and census were taken. LPAs observed S1 providing supervision & care and did not have a Criminal Record Clearance associated to the facility or any facility owned by the Licensee.

See LIC 809-D for deficiency cited

An exit interview was conducted with the facility Director.

Notice of Site Visit was left with the Director and must be posted for 30 days.

A copy of the report was left at the facility and must be made available to the public for three years upon request. A copy of an LIC 9224 was provided and discussed.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/09/2022 01:36 PM - It Cannot Be Edited


Created By: Elyse Jones On 03/09/2022 at 10:44 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: YMCA YOUTH CENTER AT RIVER ROAD PARK
FACILITY NUMBER: 334843588

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/10/2022
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidence by:
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Director agrees to associate S1 by POC due date.

Civil Penalty assessed. $100 per day for 5 days per person.
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Based on the interview/record review, the Licensee did not meet Criminal Record Clearance which poses an immediate Health, Safety & Personal Rights risk to the children in care. During the inspection LPAs observed S1 providing care & supervision and did not have a Criminal Record Clearance associated to the facility.
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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.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022


LIC809 (FAS) - (06/04)
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