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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806056
Report Date: 03/16/2022
Date Signed: 03/16/2022 09:32:04 AM


Document Has Been Signed on 03/16/2022 09:32 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/WESTMINSTER HEAD STARTFACILITY NUMBER:
364806056
ADMINISTRATOR:CARRIE GRAMFACILITY TYPE:
850
ADDRESS:720 N. SULTANA AVENUETELEPHONE:
(909) 983-0600
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY:70CENSUS: 35DATE:
03/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Site Director, Carrie GramTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Blanca Ruiz conducted a case management inspection in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency indicating that on 10/14/2021, a child at the facility alleged that a teacher hit him/her on the buttocks.

Upon arrival, LPA met with facility Site Supervisor II, Carrie Gram and stated the purpose of the inspection. Facility records were reviewed, and interviews were obtained. Video footage was requested for reviewed during inspection, but Site Supervisor II indicated that cameras are located outside the classrooms but not inside the classrooms. LPA obtained information that on 10/14/2021 a parent alleged that while bathing her child that evening, she noticed a bruise on his/her buttocks. When she asked the child about the bruised, the child stated: “My teacher hit me because I pooped my pants.” Parent asked the child which teacher, child stated: “You know, my teacher.” Staff at the facility denied the allegation and stated that such incident never occurred. Facility records reviewed did not indicate any incidents and/or injuries observed during diapering time. Additional records revealed that the child was picked up by parent at 3:54 p.m. and days later it was alleged that the child was injured at the facility. Parent stated to the facility that the incident will be reported to the Police. Legal guardian of the child was contacted and documentation of the incident in question was requested but never received during the investigation process. Random unannounced inspections were conducted at the facility by this agency to observed staff providing care and supervision and to assess overall activities. Based on the information gathered, LPA’s observation of staff’ procedures conducting care and supervision. It was determined that there is not sufficient evidence to corroborate that the facility violated California Code of Regulations, Title 22, Division 12. Facility was found to be in substantial compliance at this time. Per Site Supervisor II, the child in question returned to the facility on 03/16/2022.

An exit interview was conducted with Site Supervisor II, Carrie Gram. A Notice of Site visit was issued and must be posted for 30 days. A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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