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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370183
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:11:06 PM


Document Has Been Signed on 04/26/2022 12:11 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:NMUSD POMONA PRESCHOOLFACILITY NUMBER:
304370183
ADMINISTRATOR:CASEY, HEATHERFACILITY TYPE:
850
ADDRESS:2051 POMONA AVENUETELEPHONE:
(949) 515-6645
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:72CENSUS: 41DATE:
04/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Site supervisorTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up case management of the facility for an incident which was self reported by the facility representative to our office on 2/4/22. The initiated investigation started on 2/8/22. Today, the Covid-19 Emergency Response questionnaire was answered. LPA met with site supervisor, Heather Casey on the playground with 16 preschool children with one staff form P2 classroom. There were two staff with 12 children in P1 and two staff with 13 children in room 11. LPA met with Michelle O' Neill, Early Childhood Coordinator who arrived during inspection.
A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. (The employees are exempt from fingerprinting since they are employed by Newport Mesa Unified School District).
According to the facility self-report, a witness observed that child # 1 was not complying to the directions given. Staff # 1 reached over and grabbed child # 1 on the upper arms by both of her arms, picked child up slightly, and then put the child back down into the chair, telling the child needed to listen when staff # 1 was speaking. It was reported that staff # 1 reached over and grabbed child #1 with right arm, pulled child's face toward the direction of staff # 1 and told child needed to listen when staff # 1 was speaking.

LPA discussed the incident with the site supervisor, Heather Casey. LPA also met and interviewed Michelle O' Neill, Early Childhood Coordinator. LPA interviewed staff # 1, staff # 2, staff # 3, staff # 4 and staff # 5 regarding the above incident. LPA also interviewed 6 children including child # 1. Children did not disclose anything to support the occurrence of the above incident.

Staff # 1 stated: She did not have any intention to harm the child. She said they were doing activity at the table. Child # 1 was on the left side of staff # 1. She asked the child to sit up. Child did not answer, child got up and did not move. Staff # 1 said she was a little frustrated and she assisted the child by touching the
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: NMUSD POMONA PRESCHOOL
FACILITY NUMBER: 304370183
VISIT DATE: 04/26/2022
NARRATIVE
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Pafe 2 of 2

child’s arm to sit. She picked the child up with child’s elbows from where child was sitting. She reached under the child’s arm to put the child back on the chair.
Staff # 2 stated: She observed staff # 1 got frustrated, reached over and grabbed the child by child’s upper arms, picked up the child slightly and put the child back on the chair. Since child # 1 was still moving and standing, staff # 1 grabbed the child’s chin while pulling child's face towards staff # 1 telling the child you need to listen when I am talking.
Staff # 3 stated she had not observed staff # 1 to be physical with children.
Staff # 4 stated staff # 1 is strict. She has observed staff # 1 to be frustrated sometimes and stressed but she had not seen staff # 1 doing anything to children.
Staff # 5 stated she has not observed anything bad from staff # 1.

Although there are discrepancies in the statements between the accused staff, and the witness, and not adequate available evidence if staff # 1 was physically hard on child # 1. However, staff # 1 admitted that she was a little frustrated so staff # 1 picked child up with child's elbows and reached under child's arm to put the child back on the chair. Therefore staff # 1’s behavior was not appropriate and has violated the personal right of the child. This is a potential risk to the health and safety of children in care.
Type B citation for Personal Rights of children section 101223(a)(1) was cited on next page. Please refer to LIC 809D.

The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

Exit interview was conducted with Michelle O' Neill, Early Childhood Coordinator.

End of Report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/26/2022 12:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: NMUSD POMONA PRESCHOOL
FACILITY NUMBER: 304370183

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited

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The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by interviewing staff # 1 admitting that she picked the child up with child's elbows from
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where child was sitting. She reached under the child’s arm to put the child back on the chair out of frustration. Staff # 1’s behavior was not appropriate and has violated the personal right of the child. The facility failed to comply with this section of Title 22 Regulations. This is a potential risk to the health and safety of 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.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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