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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701204
Report Date: 12/21/2023
Date Signed: 12/21/2023 11:33:02 AM

Document Has Been Signed on 12/21/2023 11:33 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDREN'S PARADISE INC. - MELROSEFACILITY NUMBER:
376701204
ADMINISTRATOR:SHAINA CORMIERFACILITY TYPE:
840
ADDRESS:145 N MELROSE DR STE 100TELEPHONE:
(760) 724-5600
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 0DATE:
12/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Ralani DonnarummaTIME COMPLETED:
11:45 AM
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On December 21, 2024 at 1:15PM, Licensing Program Analyst (LPA) William Chancellor arrived unannounced to conduct a Case Management Visit in response to a Unusual Incident Report (UIR) received by the licensing agency on 12/11/23. During the visit, Assistant Interim Director (AD) Ralani Donnarumma was available for interview.

Documents relevant to the Unusual incident were provided and confidential interview's were conducted.

Based on information gathered, the facility acted appropriately and no violations have been identified. Parents were immediately notified and child received appropriate medical attention. This is a random isolated incident where the child feel onto their knee while playing basketball. No hazards were observed on the playground where the incident occurred.

There are no deficiencies at this time.

An exit interview was conducted, and a copy of this report was provided to facility staff. Notice of site visit must be posted for 30 consecutive days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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