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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841726
Report Date: 08/05/2021
Date Signed: 08/06/2021 01:30:59 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/06/2021 01:30 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 YMCA YOUTH CENTER AT JURUPAFACILITY NUMBER:
334841726
ADMINISTRATOR:VOELTZ, MARTHAFACILITY TYPE:
840
ADDRESS:9254 GALENA STREETTELEPHONE:
(951) 685-5241
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY: 32TOTAL ENROLLED CHILDREN: 0CENSUS: 24DATE:
08/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Gloria MartinezTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA)s, Taadhimeka Zeigler and Justin Giese conducted inspection as part of a compliance review. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:

A review of a sampling of the staff records and children's records were conducted as part of this evaluation.

The following items have been posted and are updated where necessary:
- License - Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating with the limits as stated on the license.
· Ratios are being met during this inspection.
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards.
· There are no weapons present
· There are no accessible bodies of water present.
·Water jugs and cups supply drinking water in the indoor activity space
· Medications are stored where inaccessible to children
· Hazards are stored where inaccessible to children
· Poisons and toxins are locked
· All floors shall be clean and safe
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taadhimeka Zeigler
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CORONA-NORCO FAMILY YMCA YOUTH CENTER AT JURUPA
FACILITY NUMBER: 334841726
VISIT DATE: 08/05/2021
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· Bathrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences and free of hazards
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid
· Director completed Health and Safety Training
· A review of children’s records was conducted and records were found to be complete during this inspection.
· Documentation of fire & earthquake drills to be conducted every six months
· A review of staff records on 08/05/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record
· The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

In all areas inspected today, LPA did not observe any deficiencies.

An exit interview was conducted and during the interview, staff Gloria Martinez, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.





This report is a copy of the original report that is on file with original signatures.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taadhimeka Zeigler
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
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