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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846373
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:17:51 PM

Document Has Been Signed on 11/21/2024 03:17 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EASTER SEALS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364846373
ADMINISTRATOR/
DIRECTOR:		SHAYLENE JUDSONFACILITY TYPE:
850
ADDRESS:1102 WEST PHILLIPS STREETTELEPHONE:
(909) 981-4668
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 110TOTAL ENROLLED CHILDREN: 110CENSUS: 48DATE:
11/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Estela PerezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On the date and time listed above, Licensing Program Analysts (LPAs) Eric Ramos and Perla Ordones arrived at the facility in response to the receipt of an Unusual Incident Report (UIR) that was submitted by the facility. The UIR was entered by the licensing agency on 11/14/2024. LPAs were granted entrance into the facility by facility representative Estela Perez. LPAs explained the purpose of the visit and conducted a facility tour to take census.

The UIR documents an incident pertaining to a day care child receiving an injury at the center after a device stand fell and hit their head. Pertinent parties were interviewed and stated that at the time of the incident it was circle time and the children were dancing. Pertinent parties stated that while the day care child was dancing they bumped into the cabinet that had device stand on it which caused the stand to fall. Based on interviews of pertinent parties, there were four staff members present in the room, two of which observed the incident happen. Pertinent parties stated first aid was applied to the child and the child's authorized representative was notified.

Based on the observations made and information gathered, there were no violations of the Title 22 regulations pertaining to the UIR identified at this time.

However, during the visit, while LPAs were conducting census, two staff members present, S1 and S2, were observed engaging with the day care children and who were not associated to the facility. This is a violation of Title 22 regulation 101170(e)(2) Criminal Record Clearance.

A civil penalty has been assessed during this inspection, 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.

See LIC809-D for cited deficiency.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Eric Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364846373
VISIT DATE: 11/21/2024
NARRATIVE
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LPAs Eric Ramos and Perla Ordones informed facility representative Estela Perez that this report dated 11/21/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPAs Eric Ramos and Perla Ordones also informed the facility representative Estela Perez to provide a copy of this licensing report dated 11/21/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the facility representative Estela Perez.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Eric Ramos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/21/2024 03:17 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Eric Ramos On 11/21/2024 at 02:27 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: EASTER SEALS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364846373

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
11/22/2024
Section Cited
CCR
101170(e)(2)

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(e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
This requirement is not met as evidenced by:
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Licensee agrees to have S1 and S2 associated to the facility and agrees to provide proof to Community Care Licensing (CCL) by the Plan Of Correction (POC) due date if 11/22/2024.
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Based on observation, record review and interviews the facility did not comply with the section cited above as LPAs observed two staff members present engaging with the day care children and who were not associated to the facility, which poses an immediate health and safety risk to persons in care.
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A civil penalty has been assesed for $1000.

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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:Ana Noble
LICENSING EVALUATOR NAME:Eric Ramos
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


LIC809 (FAS) - (06/04)
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