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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330907346
Report Date: 03/17/2022
Date Signed: 03/17/2022 11:40:49 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2022 and conducted by Evaluator Elyse Jones
COMPLAINT CONTROL NUMBER: 09-CC-20220217115324

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:77CENSUS: 52DATE:
03/17/2022
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Yareli Ayouby, Site Supervisor
Art Cabrera, Director		TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Child injured while in care
INVESTIGATION FINDINGS:
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On March 17, 2022 Licensing Program Analyst (LPA) Elyse Jones arrived at Corona-Norco Family YMCA to conclude and deliver findings regarding the above allegation. LPA conducted a tour of the facility inside & outside. During the investigation interviews were conducted with pertinent parties and documentation was collected.

On February 17, 2022 a complaint was received alleging a child was injured while in care. It was noted that upon pick up a child was observed to have sustained an injury to the left eye. The eye was observed to be swollen and red. The child was taken to the Emergency Room at the parents discretion for an evaluation. Per medical documentation a “foreign body” caused an injury and child was sent home the same day. It was later confirmed that the “foreign body” appeared to be sand/dirt. It was disclosed that the child alleged another child caused the injury. It was revealed during interviews with pertinent parties that the injury was caused by the wind blowing during outside play. An interview with the subject child was requested however, the request was denied at the discretion of the child’s
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 09-CC-20220217115324
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 YMCA
FACILITY NUMBER: 330907346
VISIT DATE: 03/17/2022
NARRATIVE
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parent/guardian. The Director confirmed that the injury was observed while the child was in care. It was also stated that First Aide was provided to the child and the child’s parent/guardian was notified.

Due to the conflict of information and inability to interview the child, the Department is unable to determine how the injury occurred, it was determined that the facility did not violate any Title 22 regulations.

This agency has investigated the complaint. Based on the interviews conducted, the review of pertinent documentation, and conflicting information, the allegation is UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.

No deficiencies cited at this time.

Exit interview was conducted with Art Cabrera. Notice of Site Visit was issued and must be posted for 30 day.

A copy of this report was provided to the facility 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: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4