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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842863
Report Date: 03/07/2024
Date Signed: 03/07/2024 04:20:11 PM

Document Has Been Signed on 03/07/2024 04:20 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:LEUSD LAKELAND VILLAGE PRESCHOOLFACILITY NUMBER:
334842863
ADMINISTRATOR:ADRIA GALARZAFACILITY TYPE:
850
ADDRESS:18730 GRAND AVENUETELEPHONE:
(951) 253-7400
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 24DATE:
03/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Claudia Leon and Adria GalarzaTIME COMPLETED:
04:30 PM
NARRATIVE
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On March 7, 2024 at 2:05 pm, Licensing Program Analysts (LPA) Jessica Rubio and Kelly Gerth arrived unannounced to the facility for a case management visit to follow up on an unusual incident report (UIR) dated 2/15/2024 reporting that staff (S2) witnessed staff (S1) grab a child (C1) by the upper arm and forcefully push C1 into a chair. The UIR additionally reported S1 allegedly poked C1 in the eye while they were in the bathroom. LPAs interviewed Director Adria Galarza, Supervisor Claudia Leon, staff (S3) and attempted to interview child (C1). The interview with Director revealed S1 was placed on Administrative Leave immediately after being notified of the incident. Director also revealed they began an internal investigation that is ongoing and there have been additional allegations and disclosures made against S1. Director will submit follow up UIRs. Director disclosed that while on administrative leave, S1 resigned on 2/27/2024.

The facility is being cited for Title 22 Regulation Section 101223 (a)(3). See LIC 809D for cited deficiency.

An exit interview was conducted, a copy of this report and appeal rights were reviewed and provided to Director Adria Galarza. Due to the Type A citation, an LIC 9224 was provided. The form must be signed by parents and kept on file. A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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Document Has Been Signed on 03/07/2024 04:20 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 03/07/2024 at 02:44 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD LAKELAND VILLAGE PRESCHOOL
FACILITY NUMBER: 334842863

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2024
Section Cited
CCR
101223(a)(3)

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(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...
This requirement was not met as evidenced by:
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Administrator stated that S1 no longer works for LEUSD as of 2/27/2024 and will provide proof. Director stated an Active Supervision training was also provided to staff. Mental Health Supervisor and Instructional Coach have also been on site since the incident occurred to provide support for children, parents and staff.
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Based on the unusual incindent report and interview revealing that S1 grabbed and forcefully pushed C1 and poked C1 in the eye, which poses an immediate health, safety and or 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.
SUPERVISOR'S NAME:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024


LIC809 (FAS) - (06/04)
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