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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494850
Report Date: 07/03/2025
Date Signed: 07/03/2025 02:25:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2025 and conducted by Evaluator Joe Katrdzhyan
COMPLAINT CONTROL NUMBER: 58-CC-20250701105652
FACILITY NAME:BURBANK YMCA HORACE MANN CHILDRENS CENTERFACILITY NUMBER:
197494850
ADMINISTRATOR:DIERIK GONZALEZFACILITY TYPE:
830
ADDRESS:3401 SCOTT ROADTELEPHONE:
(818) 729-1650
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:40CENSUS: 16DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director / Diane ConnellTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not report child’s injury to authorized representative.
INVESTIGATION FINDINGS:
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On 7/3/25, at 9AM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10-day complaint visit to the facility. Upon arrival, LPA met with Director / Diane Connell, who guided LPA on a tour of the facility. During the visit, LPA observed six (6) children with two (2) staff members present in the toddler program and ten (10) children with six (6) staff members present in the infant program. LPA explained that the purpose of the visit was to address the above-mentioned allegation.

During the visit, LPA conducted interviews and obtained copies of the children’s and staff rosters, along with other supporting documentation.

According to the Reporting Party (RP), it was alleged that staff failed to report a child’s injury to the child’s authorized representative.

(Please see LIC 9099C for additional information)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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 2
Control Number 58-CC-20250701105652
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BURBANK YMCA HORACE MANN CHILDRENS CENTER
FACILITY NUMBER: 197494850
VISIT DATE: 07/03/2025
NARRATIVE
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During interviews with the Director and Assistant Director, both stated they were unaware of any injuries involving Child #1. No injury was reported or disclosed to them by staff.

During the interview with Staff #1 and Staff #2, the assigned teachers in Classroom 1, both confirmed that Child #1 did not sustain any injuries on 6/12/25. According to the staff, Child #1 did not show any signs of discomfort, and no visible injury was noted before the child went home on 6/12/25. Additionally, nothing was mentioned by the parent at pick-up on that day. Staff #1 and Staff #2 reported that they first became aware of the scratch on the morning of June 13, 2025, when the parent inquired about it. Both staff members denied that the scratch on Child #1’s nose occurred at the center and stated that the scratch could have occurred after Child #1 left the facility on June 12.

Based on the investigation conducted, there is insufficient evidence to support the above-mentioned allegation to be true. Therefore, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Diane Connell, Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Joe Katrdzhyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
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