360911141-10-14-2021-12-CC-KZIS-C7SS7F-20211014133727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360911141
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:37:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PSD/DEL ROSA HEAD START		FACILITY NUMBER:	360911141
ADMINISTRATOR:	DEBBIE ARNOLD		FACILITY TYPE:	850
ADDRESS:	2382 DEL ROSA AVENUE		TELEPHONE:	(909) 883-0103
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	63	CENSUS: 31	DATE:	10/14/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Administrator, Debbie Arnold		TIME COMPLETED:	01:46 PM

NARRATIVE

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On October 15, 2021 at 10:10am Licensing Program Analyst (LPA) Kendal Zirbes met with Administrator Debbie Arnold to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report (UIR) submitted to the Department on October 7, 2021 via telephone. The unusual incident report was regarding a reporting requirements incident involving staff 1 (S1), staff 2 (S2) and child 1 (C1) that occurred on September 1, 2021. Upon arrival, there were 31 children and 12 staff present at the facility.

During this inspection LPA conducted three staff interviews and completed staff file reviews. In addition, LPA completed a safety inspection of the facility at approximately 10:20am. At this time there were no deficiencies noted. In addition, during the inspection, LPA obtained copies of documentation related to the case management incident.

LPA's record review indicated that S1, S2, have current mandated reporter training on file. Although the facility may have failed to the meet the reporting requirements at the time of the September 1, 2021 incident. All reporting requirements were met as of October 7, 2021.

Per the Administrator, as a results of the incident the Administrator, S1 and S2 will complete California Child Abuse Mandated Reporter Online training for Child Care Providers by October 22, 2021. All additional staff will complete the California Child Abuse Mandated Reporter Online training for Child Care Providers by November 15, 2021. LPA provided the Administrator with the following resource, www.mandatereporterca.com.

Based on confidential interviews and record review, during this inspection LPA Zirbes issued an Technical Violation Advisory Notice.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, where the Technical Violation Advisory Notice, this report and the Appeal Rights were discussed with the Administrator, Debbie Arnold

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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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