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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805573
Report Date: 05/25/2022
Date Signed: 05/25/2022 04:37:58 PM

Document Has Been Signed on 05/25/2022 04:37 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:OCS ST. CATHERINE OF SIENA PRESCHOOLFACILITY NUMBER:
364805573
ADMINISTRATOR:BEVERLY WINNFACILITY TYPE:
850
ADDRESS:335 N. SYCAMORE AVENUETELEPHONE:
(909) 875-7821
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 16DATE:
05/25/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Beverly WinnTIME COMPLETED:
04:40 PM
NARRATIVE
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On 05/25/2022 at time listed above Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the Facility for another purpose. LPA met with Facility Director, Beverly Winn.

At time of 1:30pm While conducting other matters LPA checked facility criminal records clearance roster and observed no staff associated to the facility. LPA Giese conducted file reviews of staff currently working in the facility and individually checked for criminal records clearances for all three staff members present at the facility. None of the three staff members at the facility had appropriate finger print clearances or association to the facility. The facility was found to be in violation of the following Title 22 regulation:

101170 (e)(1) Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department...

See LIC809D for cited Type A deficiency

A Civil Penalty of $1500 will be assessed during this inspection for Staff Criminal Record Clearance.



Continued on LIC809C
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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: OCS ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 364805573
VISIT DATE: 05/25/2022
NARRATIVE
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Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”.

YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Director understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.

Exit interview conducted and report was reviewed with the Facility representative, Beverly Winn.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/25/2022 04:37 PM - It Cannot Be Edited


Created By: Justin Giese On 05/25/2022 at 03:48 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: OCS ST. CATHERINE OF SIENA PRESCHOOL
FACILITY NUMBER: 364805573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2022
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance. (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department...
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Director understands the importance of this violation and agrees to immediately have all staff obtain criminal records clearance and association prior to returning to the facility.
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Based on records review, the facility did not comply with the section cited above. Staff #1, 2 and 3 did not have criminal records clearance or association to the facility. This poses an immediate health, safety and personal rights risk to children in care.
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Director will transfer criminal records clearances from sister school for staff to meet child ratios. if this task cannot be completed within 24 hours the facility will Voluntarily remain closed until all staff noted in this report have proper clearances.

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Justin Giese
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022


LIC809 (FAS) - (06/04)
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