<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330907346
Report Date: 08/13/2021
Date Signed: 08/13/2021 04:18:06 PM

Document Has Been Signed on 08/13/2021 04:18 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:CORONA-NORCO FAMILY YMCAFACILITY NUMBER:
330907346
ADMINISTRATOR:ART CABRERAFACILITY TYPE:
850
ADDRESS:1331 RIVER ROADTELEPHONE:
(951) 736-9622
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 77TOTAL ENROLLED CHILDREN: 77CENSUS: 35DATE:
08/13/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Art Cabrerea, DirectorTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts(LPAs) Elyse Jones and Kim Leung 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 and S2 providing supervision and care and their Criminal Record Clearances are not associated to the facility or any other 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.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/13/2021 04:18 PM - It Cannot Be Edited


Created By: Elyse Jones On 08/13/2021 at 03:55 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: CORONA-NORCO FAMILY YMCA
FACILITY NUMBER: 330907346

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited
CCR
101170(e)(2)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
Staff associated during visit.

Civil Penalty assessed. $100 per day for 5 days per person.
8
9
10
11
12
13
14
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 and S2 providing care & supervision and do not have a Criminal Record Clearance associated to the facility.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2