330907996-1-4-2022-10-CC-CMAZ-CB9M2Q-20220202081352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330907996
Report Date: 01/04/2022
Date Signed: 01/04/2022 03:24:53 PM

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
11/10/2021 and conducted by Evaluator Nasha King

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20211110145220

FACILITY NAME:	SHEPHERD OF THE VALLEY CHILD CARE CENTER		FACILITY NUMBER:	330907996
ADMINISTRATOR:	LINDA WILLIAMSON		FACILITY TYPE:	850
ADDRESS:	11650 PERRIS BOULEVARD		TELEPHONE:	(951) 924-3422
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	72	CENSUS: 16	DATE:	01/04/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Linda Williamson, Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Personal Rights- Child sustained injury while in care.
Personal Rights- Staff did not safeguard residents’ belongings.

INVESTIGATION FINDINGS:

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On 01/04/2022, Licensing Program Analyst (LPA) Nasha King conducted an unannounced complaint inspection to deliver the findings of the above complaint allegations. A 10-day inspection was initiated by LPA King on 11/15/2021. LPA was granted access to the facility by the Assistant Director, Melanie Stark. LPA toured the facility and took census. During the initial inspection on 11/12/2021, LPA King reviewed records and conducted facility observations and met with the Director, Linda Williamson. During this inspection, LPA King interviewed staff pertinent to the investigation.

It is alleged that child sustained injury while in care. It was also alleged that staff did not safeguard residents’ belongings. The following is a summation of LPA King’s investigation:

In regards to the allegation that child sustained injury while in care, interviews disclosed that no injuries had been witnessed by staff or reported for C1. Interviews conducted revealed, that there is always adequate
Please see LIC 9099C for a continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha King	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20211110145220

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: SHEPHERD OF THE VALLEY CHILD CARE CENTER	FACILITY NUMBER: 330907996
	VISIT DATE: 01/04/2022

NARRATIVE

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staffing on the playground, but none of the staff saw C1 get injured. Additionally, interviews with all parties involved revealed that no one knew when the alleged injury occurred, which is why an Ouch Report was never generated. Based on the information obtained during this investigation through interviews conducted, the review of C1’s file, and after receiving conflicting information, LPA cannot determine if C1’s injury was sustained while in care at the facility. Therefore, based on the information gathered, the allegation is UNSUBSTANTIATED.

In regards to the allegation staff did not safeguard residents’ belongings, interviews revealed that on the day that the said item was not safeguarded, the classroom had a substitute teacher who was not familiar with the classroom and were things are kept. The item was not lost, as it was on the shelf where those items are kept but was on the bottom shelf. The Director located the item on the bottom of the shelf 1-2 minutes after C1’s parent picked the child up from the facility and was provided to C1’s parents the following day. Based on the information obtained during this investigation through the interviews conducted and after receiving conflicting information, the allegation is UNSUBSTANTIATED.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and this report was reviewed with the Director, Linda Williamson and a copy of this report was provided.

Appeal rights were discussed and provided during the exit interview.

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

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha King	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

LIC9099 (FAS) - (06/04)

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