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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846127
Report Date: 04/27/2023
Date Signed: 04/27/2023 06:06:46 PM

Document Has Been Signed on 04/27/2023 06:06 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDREN'S PLACE CHILD DEVELOPMENT CENTER LLC, THEFACILITY NUMBER:
334846127
ADMINISTRATOR:FIGUEROA, AMERICA LETICIAFACILITY TYPE:
850
ADDRESS:45-114 SMURR STTELEPHONE:
(760) 619-3286
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 25TOTAL ENROLLED CHILDREN: 23CENSUS: 12DATE:
04/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:America FigueroaTIME COMPLETED:
03:05 PM
NARRATIVE
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On 04/27/2023, Licensing Program Analyst's (LPAs) Lorena Valenzuela and Jeanette Sanchez met with The Children’s Place Child Development Center, America Figueora to discuss information received during a review of an incident that occurred at Child Care Center facility.

Confidential interviews conducted revealed the facility did not report several incidents involving Child #1 to to the Department, incident in which C1 was involved in several physical altercations with children in care and staff.
Information received revealed an incident that occurred 08/09/2022, involved Child #1 (C1) hitting Child #2 (C2) in the face and causing redness and swollen to develop in C2’s face was not reported. Records review also indicated there was no written "ouch report" on file for the C2's injury.

An incident that occurred 08/30/2022, where C1 hit Child #3 (C3) in the back and C1 appears to have left C1’s imprint on C3’s back. An incident that occurred on 11/02/2022, where C1 slapped and/or kicked at least two children. An incident that occurred 10/27/2022, C1 is said to have “hit almost every kid, and all the teachers”. In addition, an incident that occurred on 09/12/2022, where C1 is said to have hit seven kids in care, was also not reported.

Based on interviews conducted and information received, the Department finds the facility did not comply with the reporting requirements. Facility is being cited under Title 22, Section 101212 (d)(1)(C) Reporting Requirements. See deficiency report, LIC 809-D for citation cited.

An exit interview was conducted, a copy of this report, the LIC 809-D, Appeal Rights, and were provided to Director America Figueroa. A Notice of Site Visit was issued and posted.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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 04/27/2023 06:06 PM - It Cannot Be Edited


Created By: Lorena Valenzuela On 04/27/2023 at 05:06 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: CHILDREN'S PLACE CHILD DEVELOPMENT CENTER LLC, THE
FACILITY NUMBER: 334846127

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
101212(d)(1)(C)

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101212 (d)(1)(C) Reporting Requirements
...a report shall be made to the Department...Events reported shall include...Any unusual incident...that threatens the physical or emotional health or safety of any child.
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Director agrees to provide staff with training on how to fill out incident reports, will review reporting requirement regulation and any other internal procedures for reporting incidents/or injuries will all staff. Will provide documentation of sign in sheets, and summary of training to the Department to by due date 05/12/2023.
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This requirement was not met as evidence by:
Based on interviews and records review, the facillity did not ensure several incidents involving Child #1 were reported to the Department. This poses a potential health, safety or personal rights risk to the 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:Deborah Mullen
LICENSING EVALUATOR NAME:Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023


LIC809 (FAS) - (06/04)
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