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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846209
Report Date: 06/26/2024
Date Signed: 06/28/2024 07:55:22 AM

Document Has Been Signed on 06/28/2024 07:55 AM - 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FERN ACADEMY EDUCATIONAL CHILDCAREFACILITY NUMBER:
364846209
ADMINISTRATOR/
DIRECTOR:		LINGLIN HEFACILITY TYPE:
850
ADDRESS:6921 SCHAEFER AVENUETELEPHONE:
(909) 696-9638
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: DATE:
06/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Ling He - Director TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rachel Zeron conducted an unannounced case management visit at the facility for the purpose of conducting an investigation pertaining to the facility's submission of an Unusual Incident Report (UIR) received by Licensing on 06/25/2024, an email was received by LPA Zeron on 06/10/2024 from the director with a brief summary of the incident. The UIR outlined an incident that occurred on 06/09/2024 pertaining to personal rights of a child in care. LPA was granted entry to the Facility and met with Facility Director, Ling He.

According to the UIR, On Friday, 06/07/2024 at approximately 12:51pm, during nap time an incident occurred in the Pre-K2 Classroom. S1 was trying to put C1 into C1's sleeping cot during the nap hour.
C1 was hiding under the table and S1 pulled C1 out aggressively. S1 flipped their cot, because S1 wanted to organize the blanket. C1 fell from the cot and accidentally hit C1's head.

On 06/26/2024 LPA made an unannounced visit to the facility for the purpose of investigating the receipt of this UIR. LPA met with Facility Director, Ling He and Assistant Director, Chini Cheng conducted interviews and reviewed video footage of the incident, and any documents related to this incident. Upon reviewing the video footage of the incident, the following was observed by LPA Zeron, C1 had crawled under the table that was placed in front of their mat during nap time, S1 walked over to the table, slightly moved the table and grabbed C1's left ankle then pulled C1 out from under by C1's left arm aggressively and placed C1 back on their cot. S1 then grabbed the the front left leg of the cot and flipped it towards the shelves directly behind C1's cot where C1 hit their head on the shelves. Interviews revealed that the management staff was aware that the incident was inappropriate and while an internal investigation is conducted, S1 will remain in the facilities private Kindergarten room.
As a result of the incident occurring and submission of the UIR to Licensing, the Facility has scheduled staff training on 06/27/2024 detailing personal rights of children in care. Director agrees to send training materials and sign-in/attendance sheets with signatures for staff that received this training.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209
VISIT DATE: 06/26/2024
NARRATIVE
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Based on LPA's interview, observation and evidence collected, its has been confirmed a Staff member inappropriately handled a child in care. The Facility was found to be in violation of the following Title 22 Regulation:

Personal Rights: 101223(a)(3)
101223 Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

See LIC809D for Type A deficiency Cited during this inspection

Exit interview conducted and report was reviewed with the Facility Director, Ling He.

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 (LIC809), Acknowledgement of Receipt of Licensing Reports (LIC9224) and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2024 07:55 AM - It Cannot Be Edited


Created By: Rachel Zeron On 06/26/2024 at 06:58 AM
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: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights: (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...

This was not met as evidenced by:
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Facility Director understands the importance of children's personal rights while in care. Facility self reported the incident, documented with video and a write up for staff involved. Facility director will conduct staff training on 06/27/2024 regarding topics of family
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Based on observation, interview and video footage obtained, Facility self reported a Staff member inappropriately handed a child in care. This ia an immediate health and safety and personal rights risk to children in care.
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service and personal rights of children.Documentation of this training and staff attendance will be sent to LPA by POC date.

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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:Aaron Ross
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


LIC809 (FAS) - (06/04)
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