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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334802158
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:25:00 PM


Document Has Been Signed on 02/15/2024 01:25 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:RCOE - HOME GARDENS HEADSTARTFACILITY NUMBER:
334802158
ADMINISTRATOR:JANIS ARNOLDFACILITY TYPE:
850
ADDRESS:13550 TOLTON AVENUETELEPHONE:
(951) 549-8492
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:34CENSUS: 22DATE:
02/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Excelsa Deo Thomas, CoordinatorTIME COMPLETED:
01:35 PM
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A Case Management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. It was alleged a child received an injury while in care.

Records were reviewed and interviews were conducted. All pertinent parties were interviewed. It was disclosed that after nap time a child was observed to have a bruise in the shape of a hand on their leg. Before pick up the child was briefly examined by a staff member and the alleged bruise was gone. All pertinent parties interviewed, disclosed the child usually sleeps in a position that could have left the mark on his/her leg.

The facility conducted an internal investigation and reported the incident to Licensing according to the Title 22 regulations. Based on information gathered, the facility acted appropriately and no violations have been identified.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Coordinator, Excelsa Deo Thomas.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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