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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334818073
Report Date: 12/10/2019
Date Signed: 12/10/2019 12:49:30 PM



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
12/09/2019 and conducted by Evaluator Alaina Wilburn
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20191209085821
FACILITY NAME:FSA-HEMET CDCFACILITY NUMBER:
334818073
ADMINISTRATOR:ALONDRA RIOS DOMINGUEZFACILITY TYPE:
850
ADDRESS:41931 E. FLORIDA AVE.TELEPHONE:
(951) 925-2160
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:102CENSUS: 38DATE:
12/10/2019
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maria GomezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Classroom roof is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced 10 day complaint visit. LPA met with Teacher Maria Gomez. Ms. Gomez took LPA on a tour of classrooms #5 and #6. Upon tour of classrooms, LPA Wilburn observed four different areas of the roof in disrepair. During today's visit, LPA did not observe a leak or buckets present to capture water. The Teacher advised the program is in an old building. During the recent heavy rain, the above mentioned classrooms experienced a leak. The facility took precautions by placing the buckets in those areas to capture water, and they made sure children were safe and unaffected by the incident. Later in visit, Director Alondra Rios arrived to assist with the visit.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. See LIC9099D for cited deficiency. Appeal rights discussed and a copy of this report was provided to the licensee on this date. A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 10-CC-20191209085821
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: FSA-HEMET CDC
FACILITY NUMBER: 334818073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited
CCR
101238(a)
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Buildings and Grounds (a)

The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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LPA Wilburn received a copy of an Invoice from L.B.C. Construction Services, dated 12/08/19. The service provided incudes a patch/seal to numerous areas on the flat roof due to the roof leak. During today's visit, LPA did not observe a leak or buckets present in the rooms; therefore it is not an immediate hazard present. Director advised on 12/12/19,
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The requirement is not met as evidenced by:

Upon tour of classrooms #5 & #6, LPA Wilburn observed four different areas where the roof is in disrepair, and the facility experienced a leak during the heavy rain. This poses a potential health and safety risk to the children in care.
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the company will return to see if the sealant is completely dried. If it is, they will do a final seal. If it is not completely dried, it will be sealed on the weekend. The roofers will return on 12/16 at 9:00am, when they will perform additional work, to ensure everything is sealed and there are no more leaks. Copies of paperwork will forwarded to LPA.
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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: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
LIC9099 (FAS) - (06/04)
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