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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910496
Report Date: 05/14/2021
Date Signed: 05/14/2021 12:40:18 PM

Document Has Been Signed on 05/14/2021 12:40 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SAN JACINTO HEADSTART/STATE PRESCHOOLFACILITY NUMBER:
330910496
ADMINISTRATOR:ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:257 GRAND ARMYTELEPHONE:
(951) 654-1531
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 82TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth ZaragozaTIME COMPLETED:
11:00 AM
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A tele-inspection case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on May 10, 2021. It indicates that Child #1 (C1) alleged that Staff #1 (S1) hit them. On May 6, 2021, the parent of C1 contacted the Director to express concerns that C1 alleged the Teacher hit them.

After speaking with the parent, the Director communicated with the Teacher, who denies ever touching C1. The classroom has an Instructional Aide (S2), who denies witnessing S1 hit C1. In addition, the Director had both staff complete a written statement about the alleged incident. The statements acknowledge that due to COVID-19 protocol, the Staff maintain a safe distance from children. Based on information gathered, the facility acted appropriately and no violations have been identified. In effort to comfort the parent, C1 was placed in another classroom, effective May 7, 2021. Also, the Director advised she will conduct a Staff In-Service training on "Communication with Parents."

LPA toured the classroom, but there are no children in attendance today because of distance learning on Fridays.

An exit interview was conducted and a copy of this report was provided to facility staff.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS

SUPERVISORS NAME: Telma Sandoval
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2021
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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