334812348-5-18-2022-10-CC-CMAZ-CERQ5K-20220525115205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334812348
Report Date: 05/18/2022
Date Signed: 05/18/2022 08:59:44 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2022 and conducted by Evaluator Sumayya Habeebulla

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20220426141809

FACILITY NAME:	RCOE-PERRIS HEAD START STATE PRESCHOOL EARLY HEAD		FACILITY NUMBER:	334812348
ADMINISTRATOR:	LORI WIEDENSOHLER		FACILITY TYPE:	830
ADDRESS:	148 AVOCADO AVENUE		TELEPHONE:	(951) 826-7200
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	63	CENSUS: 20	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Jill Wilson		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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- Day care child sustained injuries while in care
- Staff did not provide adequate supervision
- Staff did not notify day care child's parent of incident in a timely manner
- Staff did not call 911 in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Sumayya Habeebulla arrived at the facility for the purpose of conducting a subsequent complaint visit, which includes concluding the investigation and delivering the investigation findings regarding the compliant investigation initiated on 04/26/2022. LPA met with Director Jill Wilson and discussed the above allegations.

On 04/29/2022 LPA Habeebulla conducted interviews with Site Supervisor Lori Wiedensohler, and 2 staff members, all of whom are pertinent to this investigation. Along with interviews, the investigation revealed that:

See LIC 90099C for continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20220426141809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RCOE-PERRIS HEAD START STATE PRESCHOOL EARLY HEAD	FACILITY NUMBER: 334812348
	VISIT DATE: 05/18/2022

NARRATIVE

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There is an allegation that a Day care child sustained injury while in care. During investigation LPA found that C1 placed a square wooden toy with plastic frame over his head while the class was getting ready for outdoor play. The staff was unable to remove the toy because the frame got stuck at the forehead/eye area. In the process of trying to remove the toy the child got reddish marks on his forehead and eyelid area. As per interviews staff revealed that C1 himself was yanking at the toy trying to remove it off his head.

Based on the information obtained through interviews, LPA Habeebulla verified that the toy was age-appropriate, and the injuries sustained were because the child panicked and in the process of removing it forcibly, the child sustained bumps and scratches to his eyelid area/ forehead and back of his head. LPA determined that the injuries occurred as a result of the accident and not necessarily due to a lack of supervision.

The second allegation is Staff did not provide adequate supervision. During the investigation LPA determined that the classroom was adequately staffed with 2 teachers for the 6 children present in Room 16 on 04/25/2022. During the time of the incident, the staff and children were preparing for outdoor play, at which time C1 had taken the square toy and placed it on his head. S1 who was standing closest to the child noticed it instantly and approached the child in order to remove it.

Based on information obtained through interviews, it has been determined that on 04/25/2022 staff did provide adequate supervision to the children in care.

The third allegation is Staff did not notify day care child's parent of incident in a timely manner. Based on interviews, staff first tried to remove the toy presuming it would come off easily or by removing the screws to the side of the toy. As soon as it was determined the toy needs to be cut in order to be removed from the head of the child, staff had first contacted 911 and soon after that call, contacted the parent informing her of the situation.

See LIC 90099C for continuation.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20220426141809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RCOE-PERRIS HEAD START STATE PRESCHOOL EARLY HEAD	FACILITY NUMBER: 334812348
	VISIT DATE: 05/18/2022

NARRATIVE

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Based on the information obtained, it has been determined that staff reported the incident to the authorized representative in a timely manner.

The fourth allegation is staff did not call 911 in a timely manner. Based on interviews, staff presuming the toy can be removed easily tried to do it themselves. When the toy was not coming off easily from the child’s head, they removed the screws of the toy but only the side plates could be removed, and the frame of the toy was still stuck on the child’s forehead area. As soon as it was determined the frame can only be removed if cut the site supervisor called 911. The whole incident including the arrival of Paramedics took approximately 40 mins.

Based on the information obtained, it has been determined that staff called 911 in a timely manner.

From the information received by interviews with staff, and facility documents the above allegations cannot be verified. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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