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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 09/30/2022
Date Signed: 09/30/2022 09:51:41 AM


Document Has Been Signed on 09/30/2022 09:51 AM - 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:PSD/ONTARIO HEAD STARTFACILITY NUMBER:
364801214
ADMINISTRATOR:CHERIE HUDSONFACILITY TYPE:
850
ADDRESS:555 W. MAPLE AVENUETELEPHONE:
(909) 984-4117
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:224CENSUS: 52DATE:
09/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:William Alvarez/DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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On 9/30/2022 at 8:30 am, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent case management- incident inspection to deliver final report. LPA was granted access into the facility. LPA met with director, toured facility and took a census.

On 08/26/22, an Unusual Incident Report (UIR) was submitted by the facility to the Riverside Child Care Regional Office (RRO) alleging a child sustained marks under their arm, which were not present when the child was dropped off in the morning.

LPA conducted interviews with all pertinent parties, including staff. While interviewing staff, staff stated, while transitioning from outside to inside the classroom, the child was held by a staff member due to the child refusing and resisting to go inside. Although it cannot be determined if the child sustained the marks due to being held by staff; a child being held due to their refusal for going inside is considered a form of restraint and is a violation of the child’s personal rights.


See 809D for deficiency

Exit interview conducted with director. report, appeal rights, acknowledgement of receipt and Notice of Site Visit issued.

Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
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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Document Has Been Signed on 09/30/2022 09:51 AM - 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: PSD/ONTARIO HEAD START
FACILITY NUMBER: 364801214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2022
Section Cited

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Personal Rights To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature ...
This requirement was not met as evidenced by
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Based on interviews with staff a child was being held due to their refusal for going inside and is considered a form of restraint
This is an immediate risk to the health, safety and personal rights of children in care
POC discussed with director.
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An office meeting will be scheduled

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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: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2022
LIC809 (FAS) - (06/04)
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