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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010211396
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:30:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2023 and conducted by Evaluator April Wright
COMPLAINT CONTROL NUMBER: 52-CC-20230324112733
FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS DURHAMFACILITY NUMBER:
010211396
ADMINISTRATOR:SHAFFERS, NELDAFACILITY TYPE:
840
ADDRESS:40292 LESLIE STREETTELEPHONE:
(510) 683-9107
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:41CENSUS: 10DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Payton McQuillanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Personal Rights - Staff handled child in a rough manner resulting in injury
INVESTIGATION FINDINGS:
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On May 25th, 2023, at approximately 1:00pm, Licensing Program Analyst (LPA) April Wright met with Director Payton McQuillan, for an unannounced Complaint follow up inspection. The purpose of the visit is to deliver the complaint investigation findings. LPA Wright conducted a Health & Safety inspection of the facility. Present during the inspection were 10 school age children and 6 staff personnel which including the Director. All staff present today have a fingerprint clearance.
During the course of the investigation, (LPA) Wright, conducted interviews with facility personnel staff. (LPA) Wright, reviewed supporting documents submitted with the complaintant.
The Complaint alleges a child’s Personal Right’s was violated – Staff handled child in a rough manner resulting in injury. This agency has investigated this complaint. Based on LPAs interviews which were conducted, and the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Exit interview was conducted with the Director Payton McQuillan. Report was read to the Director, Appeal rights were explained and presented.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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 2
Control Number 52-CC-20230324112733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: YMCA OF THE EAST BAY Y-KIDS DURHAM
FACILITY NUMBER: 010211396
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2023
Section Cited
CCR
101223(a)(3)
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101223(a)(3) Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including
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Center director create a written plan of action and will submit to the Licensing Program Analyst detailing methods staff will use to ensure children's personal rights are not violated. Staff will also watch the CCLD Personal Rights video and each staff member will write what they have
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eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning
Based on interviews, the center director did not comply with the section cited above of maintaining the personal rights of a child subjecting them to physical restraint by a teacher which poses a potential risk to the health and safety of children in care
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learned from watching the video. These statements must be signed and dated by each staff member.
Director will provide LPA with statements by June 1st.
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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: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC9099 (FAS) - (06/04)
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