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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334818073
Report Date: 05/02/2024
Date Signed: 05/02/2024 09:35:02 AM

Substantiated


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 STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2024 and conducted by Evaluator Anastasia Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240411100506
FACILITY NAME:FSA-HEMET CDCFACILITY NUMBER:
334818073
ADMINISTRATOR:KEENA CHANDLER COLEMANFACILITY TYPE:
850
ADDRESS:41931 E. FLORIDA AVE.TELEPHONE:
(951) 429-3297
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:102CENSUS: 60DATE:
05/02/2024
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Keena ChandlerTIME COMPLETED:
09:49 AM
ALLEGATION(S):
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Staff did not comply with the terms and conditions of the admission agreement.
INVESTIGATION FINDINGS:
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On May 02, 2024, at 8:58AM, Licensing Program Analyst (LPA) Anastasia Flores, arrived for the purpose of delivering the findings of the above stated allegation. LPA met with Director Keena Chandler. On April 18th, 2024, a health and safety inspection was conducted of the facility conducted but no concerns were observed. Copies of records were obtained. Interviews were conducted with Staff #1, 2, 3, 4, 5, (S1, S2, S3, S4, S5).
On April 11, 2024, this agency received allegation that staff did not comply with the terms and conditions of the admission agreement. It was reported that Child 1(C1) was disenrolled from the program and that it did not comply with the parent admission agreement. Interview with Child Care Director, informed LPA that C1 was disenrolled due to lack of communication for over thirty days. Confidential records review show that C1 was disenrolled from the facility on 3/22/24. Confidential interviews disclosed the last contact with S1 was on 3/07/24 via telephone. Interview with Director, admitted to the error of disenrolling C1 from the program. Interview with Administrator, and records review reveal that C1 was disenrolled prior to the 30 days as stated for reasons for termination.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 10-CC-20240411100506
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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-HEMET CDC
FACILITY NUMBER: 334818073
VISIT DATE: 05/02/2024
NARRATIVE
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Based on interviews and record review, the preponderance of evidence has been met, therefore, the allegation that the staff did not comply with the terms and conditions of the admission agreement is substantiated. The facility is being cited for Title 22, Division 12, Chapter 1, Article 6, section 101219(f) Admission Agreement, see 9099D for deficiencies.

An exit interview was conducted, a copy of this report, 9099D, Appeal Rights and Notice of Site Visit were provided to Director, Keena Chandler. The licensee was reminded that the Notice of Site visit must remain posted for 30 consecutive days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20240411100506
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FSA-HEMET CDC
FACILITY NUMBER: 334818073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2024
Section Cited
CCR
101219(f)
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101219(f) Admission Agreement: the licensee shall comply with all terms and conditions set forth in the admission agreement, this was not met as evidenced by….
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Director met with the parent of C1, the facility is working to meet the needs of the child. Director is implementing a parent communication log to avoid any future mis-communication with the parents/guardians.
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Based on record review and interviews conducted, child #1 was disenrolled on 3/22/24, with the most recent contact with the facility on 3/07/24, this violated the admissions agreement for the facility. This poses a potential health, safety and personal rights risk to children 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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3