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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811841
Report Date: 12/02/2021
Date Signed: 12/02/2021 03:13:03 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:PESD-ROB REINER CHILDREN & FAMILIES DEV. CTR.FACILITY NUMBER:
334811841
ADMINISTRATOR:JACQUELINE HOWEFACILITY TYPE:
850
ADDRESS:2221 S. A STREETTELEPHONE:
(951) 657-1441
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:237CENSUS: 206DATE:
12/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jacqueline Howe - Director TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Rachel Zeron and Licensing Program Manager (LPM) Stephanie Hudak arrived at the facility to follow up on an unusual incident that was submitted by the facility November 10, 2021. LPA met with Director Jacqueline Howe. LPA took census, conducted interviews and toured the facility where the incident occurred.

Per the Director November 1, 2021 at approximately 2:35pm there were 25 children in care under the supervision of 6 staff members on the playground.

Child #1 while trying to climb across to the next Stepping pod (play structure) the child missed the next pod, as a result the child fell off the landing on their left arm. The child was transported to the health office, first aide/ice provided. Child #1 was picked up from the facility by their authorized representative. Later in the evening the child's parent took the child to the Urgent care and could not be diagnosed at that time. On November 11th, Child #1 was diagnosed with a fractured left arm. Per the Director Child #1 is anticipated to return to the facility on December 13,2021.

Staff #1 was present and witnessed the incident but could not foresee child #1 falling, and landing on their left arm.

Based on the information obtained during the visit, as well as an inspection of the play structure there appeared to be no violations of Title 22 Regulations pertaining to the reported incident. An exit interview was held with Director Jacqueline Howe. No deficiency cited at this time.

A notice of site visit was provided and required to be posted for the next 30 days.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4207
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
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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