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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330910042
Report Date: 06/13/2019
Date Signed: 06/13/2019 10:42:38 AM



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
05/29/2019 and conducted by Evaluator Sharleen Robinson
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20190529150913
FACILITY NAME:RSD-ROMOLAND HEAD START AND STATE PRESCHOOLFACILITY NUMBER:
330910042
ADMINISTRATOR:VANESSA RODRIGUEZFACILITY TYPE:
850
ADDRESS:25890 ANTELOPE ROADTELEPHONE:
(951) 928-2924
CITY:ROMOLANDSTATE: CAZIP CODE:
92585
CAPACITY:59CENSUS: 19DATE:
06/13/2019
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Vanessa Rodriguez, DirectorTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Admission Agreement: Staff video recorded day care child without authorized representative’s permission.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Sharleen Robinson and Susan Brewer arrived at the facility to follow up on a complaint investigation that was initiated June 4, 2019, LPAs met with Director Vanessa Rodriguez. A census was taken, and the facility was toured. It was alleged that Staff video recorded day care child without authorized representative’s permission.

During the investigation, LPA Robinson made observations, conducted interviews with staff and all other relevant individuals pertinent to this investigation.

During interviews, a Staff member admitted on or about October 11, 2018, a child displayed disruptive behavior, therefore the staff member used an IPAD that belong to the facility to video record the child’s disruptive behaviors. The Staff member admitted they did not have the child’s authorized reprehensive consent to video record the child’s disruptive behavior. It was also disclosed that the staff member recorded the child, in efforts of showing the child’s authorized representative and the school mental health consultant. See LIC9099C for the remainder of the report>>>
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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-20190529150913
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: RSD-ROMOLAND HEAD START AND STATE PRESCHOOL
FACILITY NUMBER: 330910042
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
CCR
101219(f)
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Admission Agreements: The licensee shall comply with all terms and conditions set forth in the admission agreement. This requirement was not met as evidenced by: a staff member admitted on or about October 11, 2018, a child displayed disruptive behavior, therefore the staff member used the facility IPAD to video record the child’s disruptive behavior. The staff member admitted they did not have the child’s authorized representative’s consent to video record the child’s behaviors, this is a potential risk to the health and safety of children in care.

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1. Staff deleted the video during the month of October in 2018. 2. The facility will immediately ensure the facility strictly adhere to the conditions set forth in the admission agreement.
3. The Director agrees to submit a written plan to Community Care Licensing by the due date of 6/21/19, detailing how the facility will ensure the cited deficiency will not be repeated.
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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: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20190529150913
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: RSD-ROMOLAND HEAD START AND STATE PRESCHOOL
FACILITY NUMBER: 330910042
VISIT DATE: 06/13/2019
NARRATIVE
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During observations, LPA discovered that the admission agreement signed by the child’s representative does not authorize facility staff to record the child’s disruptive behavior. The parent handbook and or the admissions agreement does not state staff will video tape children’s disruptive behaviors.

The evidence gathered during the investigation revealed that a staff member admitted to video recording a child’s disruptive behavior without the child’s authorized representative’s consent, therefore the preponderance of evidence standard has been met, therefore the above admission agreements allegation is found to be SUBSTANTIATED. See LIC9099D for citation.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3