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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805395
Report Date: 02/25/2020
Date Signed: 02/25/2020 11:58:45 AM

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ARMADA ELEMENTARY HEAD STARTFACILITY NUMBER:
334805395
ADMINISTRATOR:DARLENE MINJAREZFACILITY TYPE:
850
ADDRESS:25201 JOHN F KENNEDY DRIVETELEPHONE:
(951) 485-5886
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY:119CENSUS: 19DATE:
02/25/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Jennifer Adcock-AdministratorTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) La Kesha Edwards made an unannounced case management visit to the facility and met with Jennifer Adcock-Administrator.

A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on February 20, 2020. It indicates that a staff member touched and pulled children's ears when they were not listening. It was also reported the staff member was observed holding one of the children upside down upon by the ankles and tickled the child's back at the end of nap time.

Facility records were reviewed and the Administrator, Jennifer Adcock, and one staff member were interviewed at the facility while the alleged staff were interviewed over the phone due to being on administrative leave. Alleged Staff did admit that they sometimes will touch children's ears to remind the children of the importance of listening. When LPA interviewed two children, both children stated their ears were pulled and one child stated it hurt and showed LPA by pressing the finger of the LPA with firmness. When the child was asked about being held upside down by the ankles how did the child feel? The child stated it was scary. Based on the information gathered, the following violations have been identified: Personal Rights 101223(a)(3)

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility staff.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ARMADA ELEMENTARY HEAD START
FACILITY NUMBER: 334805395
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2020
Section Cited

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This report has been AMENDED to make corrections. 101223 Personal Rights:The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, including but not limited to: interference with functions of daily living...
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 including eating, sleeping or toileting; This requirement was not met as evidence by: Staff member admitted to touching children's ears and picked one child up slowing swinging and tickling the back of the child after nap time. 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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2020
LIC809 (FAS) - (06/04)
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