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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906598
Report Date: 10/04/2019
Date Signed: 10/04/2019 11:01:23 AM

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:CJUSD/SAN SALVADOR CHILDREN'S CENTERFACILITY NUMBER:
360906598
ADMINISTRATOR:MACK, MELISSAFACILITY TYPE:
850
ADDRESS:471 AGUA MANSA ROADTELEPHONE:
(909) 876-4154
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY:120CENSUS: 66DATE:
10/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Mariana Mitroi, Child Development SupervisorTIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analyst (LPA), Carlos Martinez, arrived to follow up on an unusual incident report that was submitted to Licensing by the facility on 10/01/19. LPA met with the Mariana Mitroi, Child Development Supervisor, who allowed LPA entry into facility. The UIR documented an incident involving a child being left alone, without supervision, in a restroom.

On October 1, 2019, Child #1 was found alone in the restroom by an instructional assistant from another classroom. Consequently, Child #1 was returned to her classroom and a supervisor was informed of the incident. According to Mitroi, the incident occurred shortly after the class had gone on a restroom break and children had lined up for a head count. While in line, another child ran out of place and a teacher ran after the child to bring him back. An internal investigation revealed that Child #1 then ran off back into the restroom while the other child wandered off and was not accounted for when they went back into the classroom.

Staff admitted that a second head count was not conducted after returning to the classroom, and were unaware she was missing until she was found by another staff, and therefore did not provide adequate care and/or supervision.

See LIC809D for cited deficiencies.
Appeal rights discussed and a copy of this report was provided to the licensee on this date

An exit interview was conducted, and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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: CJUSD/SAN SALVADOR CHILDREN'S CENTER
FACILITY NUMBER: 360906598
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2019
Section Cited

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION:

No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time. This requirement is not met as evidenced by: LPA confirmed that Child #1 was left alone, in a restroom,
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without any supervision for approximately 5 minutes. This poses an immediate health and safety risk to children in care.
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Deficiency was cleared during this visit.

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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2019
LIC809 (FAS) - (06/04)
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