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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270065
Report Date: 11/19/2024
Date Signed: 11/19/2024 12:52:46 PM

Document Has Been Signed on 11/19/2024 12:52 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SADDLEBACK YMCA-BATHGATE CENTERFACILITY NUMBER:
304270065
ADMINISTRATOR/
DIRECTOR:		JESSICA CERVANTESFACILITY TYPE:
840
ADDRESS:27642 NAPOLI WAYTELEPHONE:
(949) 363-7089
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 100TOTAL ENROLLED CHILDREN: 105CENSUS: 0DATE:
11/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Allison WongTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 11/18/2024. LPA toured the facility and met with Director Allison Wong. There were no children present upon arrival.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

On 11/18/2024, a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported child #1 (C1) being left unattended without any supervision inside the children's bathroom for approximately 3 to 4 minutes on 11/15/2024. Director stated the parent arrived for pick up at approximately 4:00 PM and that is when staff noticed C1 was missing.

Based on interview and UIR submitted, it was revealed that child (C1) was left alone on 11/15/2024, without any adult supervision inside the bathroom. C1 was left unattended for about 3 - 4 minutes until parent of child (C1) arrived. The following violation Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SADDLEBACK YMCA-BATHGATE CENTER
FACILITY NUMBER: 304270065
VISIT DATE: 11/19/2024
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LPA Thompson informed Director Allison Wong that this report dated 11/19/2024, document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed Director Allison Wong to provide a copy of this licensing report dated 11/19/2024, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Allison Wong. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/19/2024 12:52 PM - It Cannot Be Edited


Created By: Dean Thompson On 11/19/2024 at 12:28 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SADDLEBACK YMCA-BATHGATE CENTER
FACILITY NUMBER: 304270065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2024
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.... Supervision shall include visual observation.

This requirement was not met by:
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Director will train staff on YMCA standard operating procedures which include all aspects of safety and supervision.
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Based on staff interview and UIR submitted, the licensee did not comply with the section cited above. C1 was left alone on 11/15/2024 without any adult supervision inside the bathroom for 3 to 4 minutes, which poses an immediate health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


LIC809 (FAS) - (06/04)
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