<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808610
Report Date: 04/10/2019
Date Signed: 11/01/2019 09:13:20 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RENU HOPE FOUNDATIONFACILITY NUMBER:
334808610
ADMINISTRATOR:SULTANA AHMADFACILITY TYPE:
850
ADDRESS:1675 N. PERRIS BLVD., #HTELEPHONE:
(951) 657-1395
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:95CENSUS: 60DATE:
04/10/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Sultana Ahmad,Site SupervisorTIME COMPLETED:
09:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On date and time listed above, an unannounced Case Management visit was conducted regarding an unusual incident, which was self reported by the facility on April 8, 2019. LPA met and toured the facility with Sultana Ahmad, Site Supervisor. There were 60 Preschool children in care.

On April 5, 2019 at approximately 2:25pm, two staff members engaged in a verbal and physical altercation at the facility in an unoccupied classroom (no preschool children present). Due to the altercation, the local police were called and one of the staff members, the aggressor, was placed on administrative leave.

The facility took appropriate action by immediately notifying Community Care Licensing. An exit interview was conducted. The Notice of Site Visit was posted and must stay posted for 30 days. A copy of this report was provided to the Site Supervisor on this date.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
Citations on this Visit Report are Under Appeal!

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RENU HOPE FOUNDATION
FACILITY NUMBER: 334808610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
04/11/2019
Section Cited

1
2
3
4
5
6
7
101216(a)Child care center personnel shall be competent to provide the services necessary to meet the individual needs of children in care and shall at all times be employed in numbers sufficient to meet those needs. Facility staff did not adhere to this regulation, this is evident by the following: on April 4, 2019 at approximately 2:25pm staff #1 and staff #2 got into verbal and physical altercations during day care hours of operation while working at the facility.

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: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2