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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811267
Report Date: 11/21/2019
Date Signed: 11/21/2019 01:20:57 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 PRESCHOOL HEALD ACADEMYFACILITY NUMBER:
334811267
ADMINISTRATOR:ADRIA GALARZAFACILITY TYPE:
850
ADDRESS:601 W. HEALD STREETTELEPHONE:
(951) 471-2760
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:63CENSUS: 52DATE:
11/21/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sarah YatesTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joanne Domingo arrived at the facility to conduct a Case Management visit in response to the receipt of an unusual incident report (UIR) from the facility. LPA, Domingo met with Supervisor, Sarah Yates to discuss the purpose of the visit, toured the facility and conducted census.
On 11/14/19, two staff members from the State Preschool program witnessed a staff member mishandle a child while taking the child to the bathroom. Staff #1 was observed holding Child #1 by the hand and leading the child to the bathroom. In the process Child #1 tripped and landed forward on their knees. Staff #1 picked up Child #1 placed the child over their shoulder with the child facing forward. It was disclosed that the staff member is a substitute aide for LEUSD. The staff member was also observed to be wearing an ear bud and at times appeared to be conversing with themselves. It was later learned that the ear bud constitutes using a cell phone while working and is in violation of LEUSD policy. LEUSD has been notified of the incident and requested by the State Preschool and Head Start Children and Family Services to be removed from the list of substitute staff for all State Preschool and Head Start facilities in the LEUSD.

SEE LIC 809D FOR DEFICIENCIES CITED DURING THIS VISIT.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC809D) CITED DURING THIS INSPECTION. UPON RECEIPT A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS/ GUARDIANS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.

An exit interview was conducted, appeal rights discussed and provided along with a copy of form LIC 9224 (AB 633) and a copy of this report on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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: LAKE ELSINORE PRESCHOOL HEALD ACADEMY
FACILITY NUMBER: 334811267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2019
Section Cited

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PERSONAL RIGHTS
The licensee shall ensure that each child accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as witnesses observed a staff
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member mishandle a child which poses an immediate Health and Safety risk to 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: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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