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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334810701
Report Date: 01/31/2020
Date Signed: 01/31/2020 01:28:45 PM

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:LAKE ELSINORE USD HEAD START JEANNETTE ELLIS CTR.FACILITY NUMBER:
334810701
ADMINISTRATOR:FRIEDA BRANDSFACILITY TYPE:
850
ADDRESS:411 W. HEALD STREETTELEPHONE:
(951) 245-4794
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:81CENSUS: 0DATE:
01/31/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Claudia LeonTIME COMPLETED:
01:30 PM
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LPA, Joanne Domingo arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 12/06/19. LPA Joanne Domingo met with Director and staff to discuss the reported incident.

It is alleged that on 12/3/19, Child #1 disclosed to their parent that another child touched Child #1 in their rear end. It was disclosed that during outside play on 12/3/19, the children from Rooms #2 & #4 share the playground from 9:15am - 10:15. There were 27 children and 5 staff members supervising the playground. In addition, Director, Claudia Leon was observing the playground from inside classroom #3. A Program Development Specialist from RCOE was also outside reviewing the outdoor time. Child #1 alleges the incident occurred while on the swings. However, all staff do not recall any children playing on the swings as the area where the swings are located was soaked from the rain the previous day. Staff recalled the children playing on the black top, at the tables or the climbing structure. Furthermore, Child #1 is very vocal if hurt or in pain or if friends are not playing nicely. On that day, staff do not recall Child #1 indicating they were hurt. Child #1 was relocated to another LEUSD facility per their parent as of 12/09/19.
Based on the information obtained during the visit, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Director, Claudia Leon. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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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