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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372005131
Report Date: 04/27/2023
Date Signed: 04/27/2023 02:59:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2023 and conducted by Evaluator Jessica M Rubio
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20230425142238
FACILITY NAME:BALDERRAMA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
372005131
ADMINISTRATOR:KHAN, ALIYAFACILITY TYPE:
850
ADDRESS:709 SAN DIEGO ST.TELEPHONE:
(760) 757-1931
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY:80CENSUS: 39DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Andrea Yates and LIta MooreTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff handled child in a rough manner
Staff did not report incidents to responsible party
INVESTIGATION FINDINGS:
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On April 27, 2023 at 10:20 am, Licensing Program Analyst (LPA) Jessica Rubio arrived unannounced to Balderrama Child Development Center, (CCC) to initiate the complaint investigation regarding the allegations listed above. LPA met with Interim Director Andrea Yates and Program Director Lita Moore. LPA conducted a tour, census and interviews with one child (C1) and staff.

On April 25, 2023, a complaint was received alleging staff handled child in a rough manner; specifically, that in one incident, S2 restrained C1 and in another incident, date unknown, S1 pinched C1. It was also alleged that staff did not report incidents to responsible party; specifically, that S1 did not notify C1’s parent’s of the incident as required.

(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 10-CC-20230425142238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BALDERRAMA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 372005131
VISIT DATE: 04/27/2023
NARRATIVE
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Regarding the allegation that S2 restrained C1, interviews revealed that C1 exhibited behaviors that included hitting and kicking, that would often lead to C1 being removed from the classroom and taken to S1’s office by S2. Interviews revealed that approximately March 30, 2023, after an incident of C1 being taken to S1’s office, S2 restrained C1 by wrapping their arms and legs around C1’s body and legs. A witness interview revealed C1 was restrained anywhere between 15 and 30 minutes. S2 also admitted to restraining C1. Regarding S1 allegedly pinching C1, C1 did not reveal C1 had been pinched by C1, however C1 did reveal that S1 would hit C1 while in a chair. Interviews with staff revealed no staff had seen S1 hit or pinch C1.

Regarding the allegation that S1 did not report the behavioral incident or restraint to C1’s responsible party, interviews revealed that S1 was in the office with S2 and witnessed C1 being restrained, however did not inform C1’s parents of the incident.

Based on confidential interviews conducted during the investigation, the preponderance of evidence standard has been met and the allegations staff handled child in a rough manner and staff did not report incidents to responsible party are substantiated. The facility is being cited for Title 22 Regulations Sections 101223 (a)(3) and 101212 (f). See LIC 9099-D for cited deficiencies.

An exit interview was conducted, appeal rights discussed and given to the licensee along with a copy of this report was provided to Program Director Lita Moore. LPA also informed Program Director a signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LIC 9224 was provided. 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: 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
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20230425142238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BALDERRAMA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 372005131
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2023
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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Program Director stated S2 as well as S1 are no longer employed at the facility and all staff will be retrained on the personal rights of children on May 2, 2023.
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Based on interviews revealing that S2 restrained C1 for approximately 15-30 minutes, which poses an immediate health, safety and/or personal rights risk to children in care.
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Type B
05/04/2023
Section Cited
CCR
101212
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(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.
This requirement was not met as evidenced by:
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Program Director stated a training will be held on May 2, 2023 regarding reporting requirements. A sign in sheet and agenda will be provided to LPA.
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S1 did not inform C1's parents of an unusual incident invlolving C1, which poses a potential 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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
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
LIC9099 (FAS) - (06/04)
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