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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806734
Report Date: 05/06/2026
Date Signed: 05/06/2026 03:50:02 PM

Document Has Been Signed on 05/06/2026 03:50 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:YMCA ARROYO VERDE SCHOOL-AGE SITEFACILITY NUMBER:
364806734
ADMINISTRATOR/
DIRECTOR:		MALINA ALVAREZFACILITY TYPE:
840
ADDRESS:7701 CHURCH STREETTELEPHONE:
(909) 735-2609
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 60TOTAL ENROLLED CHILDREN: 28CENSUS: 24DATE:
05/06/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Malina AlvarezTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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On 05/06/2026 at time listed above Licensing Program Analyst (LPA) Justin Giese conducted an unannounced visit to the facility for another purpose. LPA met with Director, Malina Alvarez and discussed the following.

On 04/20/2026 LPA conducted an unannounced visit to the Facility for another purpose. During this visit, LPA reviewed pertinent Facility records. It was observed that the Facility had documented incidents regarding lapse/lack of supervision for children in care. It was disclosed that Staff #1 had allowed children in care to use the detached facility restroom without providing proper visual supervision. It was noted this incident occurred during outdoor play; children were allowed to walk to the restrooms out of Staff #1’s view for undisclosed periods of time. Additionally, it was noted Staff #1 was observed using their personal cellular phone while children were at play. This incident was not reported to the Licensing office when it had occurred.

The facility was found to be in violation of the following Title 22 regulations: See LIC809D for cited Type B deficiencies

101229(a)(1) Responsibility for Providing Care and Supervision
101212(d)(1)(C) Reporting Requirements

An exit interview was conducted, LPA provided Director, Malina Alvarez with a copy of this report, appeal rights, LIC811 (confidential names) and a notice of site visit on 05/06/2026.
Notice of Site Visit must remain posted for the next 30 days.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Justin Giese
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/06/2026 03:50 PM - It Cannot Be Edited


Created By: Justin Giese On 05/06/2026 at 02:59 PM
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 ARROYO VERDE SCHOOL-AGE SITE
FACILITY NUMBER: 364806734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time…
This was not met as evidenced by:
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Director has agreed to conduct additional training with staff regarding maintaining proper supervision of children in care. Training materials and signed staff acknowledgement will be submitted to LPA on or before the stated POC date of 05/13/2026.
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Based on observation and interview, Staff #1 allowed children to use the detached restroom without providing proper visual supervision. This poses a potential health/safety or personal rights risk to children in care.
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Type B
05/13/2026
Section Cited
CCR101212(d)(1)(C)

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Reporting Requirements (d) Upon the occurrence… a report shall be made to the Department by telephone… In addition, a written report containing the information… shall be submitted to the Department within seven days… (C) Any unusual incident….
This was not met as evidenced by:
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Director has agreed to submit a memo of understanding regarding this regulation and steps the facility will take to maintain reporting requirements. Signed acknowledgement will be submitted to LPA on or before the stated POC date of 05/13/2026.
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Based on observation and interview, Director had knowledge that Staff #1 allowed children to use the detached restroom without providing proper visual supervision and did not report the incident to Licensing as required. This poses a potential health/safety or 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.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Justin Giese
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2026


LIC809 (FAS) - (06/04)
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