330908825-7-10-2023-09-CC-GSEA-CTNKLP-20230712080014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330908825
Report Date: 07/10/2023
Date Signed: 07/10/2023 02:48:47 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 ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2023 and conducted by Evaluator Giselle Carbullido

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20230707135943

FACILITY NAME:	FIRST CHRISTIAN CHURCH PRESCHOOL		FACILITY NUMBER:	330908825
ADMINISTRATOR:	LISA VILLA		FACILITY TYPE:	830
ADDRESS:	4055 JURUPA		TELEPHONE:	(951) 683-5780
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY:	22	CENSUS: 9	DATE:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Kimberly Eaton		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff inappropriately handles an infant.

INVESTIGATION FINDINGS:

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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an investigation in regard to the above complaint received on 07/07/2023. LPA was given access to the facility by Kimberly Eaton, Director. LPA discussed purpose of visit, took census, and toured the facility. LPA met with the Director to further discuss the complaint allegations and deliver findings.
During this investigation, LPA interviewed all pertinent parties including 6 staff.

It was alleged staff inappropriately handled an infant by not following instructions received from management and parent for an infant with a clavicle/arm injury.
Pertinent parties stated infant teachers received verbal instruction and demonstration from management on how to assist the infant by lifting from infants’ bottom/back and not pulling or guiding from upper body. Pertinent parties reported witnessing a staff lifting the infant by the arm into a chair resulting in the infant crying and reporting this concern to management.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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 09-CC-20230707135943

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FIRST CHRISTIAN CHURCH PRESCHOOL	FACILITY NUMBER: 330908825
	VISIT DATE: 07/10/2023

NARRATIVE

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Based on LPA’s interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED per California Code of Regulations, Title 22, Division 12. See LIC9099D for cited deficiencies.

LPA Carbullido informed licensee facility representative, Kimberly Eaton that this report dated 07/10/2023 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Carbullido informed the facility representative to provide a copy of this licensing report dated 07/10/2023 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.

Appeal rights issued and discussed with Director Kimberly Eaton and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report and Notice of Site Visit were provided to the Director Kimberly Eaton. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20230707135943

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FIRST CHRISTIAN CHURCH PRESCHOOL	FACILITY NUMBER: 330908825
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/11/2023 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223(a)(2) Personal Rights-(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by	1 2 3 4 5 6 7	Facility will complete staff retraining for all infants requiring medical accommodations and submit staff attendance, agenda items, and statement of understanding on Personal rights to the department by the POC due date: 07/11/23.
	8 9 10 11 12 13 14	Based on interviews conducted the facility did not comply with the section above in that staff failed to follow instructions for an infant with an arm/clavicle injury. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

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