334830521-7-19-2023-09-CC-GCAO-CTVS54-20230719133342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334830521
Report Date: 07/19/2023
Date Signed: 07/19/2023 01:33:52 PM

Document Has Been Signed on 07/19/2023 01:33 PM - It Cannot Be Edited

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	FSA-MAGNOLIA CDC		FACILITY NUMBER:	334830521
ADMINISTRATOR:	LESLIE COX		FACILITY TYPE:	850
ADDRESS:	8172 MAGNOLIA AVE.		TELEPHONE:	(951) 353-0129
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	156	CENSUS: 69	DATE:	07/19/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alondra Dominguez and Vanessa Jara		TIME COMPLETED:	01:35 PM

NARRATIVE

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On the date and time listed above, a case management visit is being conducted in response to the receipt of two unusual incident reports (UIRs) from the facility. Both UIRs were received by the licensing agency on 07/10/2023. The UIRs indicated staff mishandled a child while in care on 07/05/23 and the other UIR indicated staff denied a child a snack and denied assistance for a crying child on 07/06/23.

At time of visit, LPA toured the facility, took census, reviewed records and conducted interviews with pertinent parties including 7 staff.

Regarding the first UIR, it was reported a staff mishandled a child while in care. It was reported a staff held and moved a child by the shoulders and sat them down roughly, startling the child.

Pertinent parties reported they are trained when a child needs assistance to hold out their hands and/ or verbally offer help or encourage the child to get up on their own. Pertinent parties also reported conflicting information on how to assist children with special needs or if the incident occurred.

Due to conflicting information reported, LPA was unable to determine if a violation occurred for this incident.

Based on the information obtained during the visit, at this time, there appeared to be no violations of Title 22 Regulations pertaining to this reported incident.

Regarding the second UIR, it was reported that a staff denied a child a snack and denied assistance for a crying child.

Regarding denying a child a snack, interviews with pertinent parties reported a staff gave verbal instruction to not give a Popsicle to a child who had a rough morning resulting in the child crying. Interviews also revealed a verbal disagreement about the Popsicle arose between two staff in front of the child and other children, requiring intervention from a third staff.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FSA-MAGNOLIA CDC	FACILITY NUMBER: 334830521
	VISIT DATE: 07/19/2023

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Regarding denying a child a snack, interviews with pertinent parties reported a staff gave verbal instruction to not give a snack (Popsicle) to a child who had a rough morning resulting in the child crying. Interviews also revealed a verbal disagreement about the Popsicle arose between two staff in front of the child and other children, requiring intervention from a third staff.

Regarding denying assistance to a child, pertinent parties reported a staff gave verbal instruction to not help a child in distress (crying and seeking hugs). Pertinent parties stated due to child being in distress other staff had to intervene and provide care and comfort resulting in the child calming down.

Based on the information gathered, the following violations have been identified: 101223(a)(1) Personal Rights: To be accorded dignity in his/her personal relationships with staff and other persons.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

LPA Carbullido informed facility representatives, Alondra Dominguez and Vanessa Jara that this report dated 07/19/2023 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Carbullido informed the facility representatives to provide a copy of this licensing report dated 07/19/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights issued and discussed with site directors Alondra Dominguez and Vanessa Jara and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report and Notice of Site Visit were provided to the site directors Alondra Dominguez and Vanessa Jara. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/19/2023 01:33 PM - It Cannot Be Edited

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FSA-MAGNOLIA CDC	FACILITY NUMBER: 334830521
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/20/2023 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	101223(a)(1) Personal Rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility will submit a written plan of action for ensuring children are accorded dignity in their relationships with staff including how facility will monitor concerns with employees, to the department by POC due date 07/19/23.
	8 9 10 11 12 13 14	Based on interviews conducted facility did not accord the dignity of children in care in their personal relationships with staff. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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