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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844562
Report Date: 10/17/2022
Date Signed: 10/17/2022 02:46:01 PM


Document Has Been Signed on 10/17/2022 02:46 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:HEMET ELEMENTARY PRESCHOOLFACILITY NUMBER:
334844562
ADMINISTRATOR:CHUNG, NGOC HAHNFACILITY TYPE:
850
ADDRESS:220 S. FRANKLIN ST.TELEPHONE:
(951) 765-1648
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:106CENSUS: 28DATE:
10/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Melina Serna - Preschool PrincipalTIME COMPLETED:
03:05 PM
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On the date and time listed, Licensing Program Analyst (LPA) Nasha King arrived at the facility to conduct a Case Management (Incident) follow-up visit on an Unusual Incident Reported dated 06/02/2022 and received by the Community Care Licensing (CCL) on 06/03/2022. LPA met with Preschool Principal, Melina Serna, to discuss the incident. A tour of the facility was granted, and census was conducted.

It was reported on 06/01/2022 that a child became upset during snack time because their name tag was removed from their chair. C1 picked up chairs and started throwing them one after the other. C1 then took their shoes off and started to throw them at the children sitting at the table. A confidential interview with S1 revealed that S1 briefly restrained C1 in order to protect the other children. S1 did try redirecting C1, but the attempts were unsuccessful, as C1 continued to demonstrate harmful behaviors towards themselves and the other students.

LPA has determined that the facility staff took the necessary steps to ensure the health and safety of the children in care. Based on the information gathered, there appears to be no violations of Title 22 Regulations found at this time, and therefore, there were no deficiencies cited during this inspection.

An exit interview was conducted, and this report was reviewed with the Preschool Principal, and a copy was provided.

Appeal rights were discussed and provided during the exit interview.

A Notice of Site visit was given, and the Licensee understands that it must remain posted for 30 days.

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2022
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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