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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820599
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:43:29 PM

Document Has Been Signed on 06/05/2024 12:43 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VOLUNTEERS OF AMERICAFACILITY NUMBER:
364820599
ADMINISTRATOR/
DIRECTOR:		GLORIA DELGADOFACILITY TYPE:
850
ADDRESS:720 S. E STREETTELEPHONE:
(909) 888-4577
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 19DATE:
06/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Gloria DelgadoTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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On 06/05/2024 Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of investigating the submission of an Unusual Incident Report (UIR). The UIR outlined an incident which occurred on 05/10/2024 pertaining to Supervision. LPA met with Center Coordinator, Gloria Delgado and discussed the following:

The UIR submitted to the Regional Office outlined an incident which occurred on 05/10/2024. According to UIR around 11:00am on 05/10/2024 Facility Staff were transitioning children from the outdoor activity space back inside the Facility. It was reported Staff did not notice a child had ran back to the outdoor area and was subsequently left alone outside. It was estimated the child was left unattended for a period of five minutes before they were discovered by another Staff.

Based on self-reporting of this incident and statements recorded from interviewing Site Coordinator, the Facility acknowledges this incident occurred and assumes all responsibility.

The facility was found be in violation of the following Title 22 Regulation:

101229(a)(1) Responsibility for Providing Care and Supervision
(a)The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time… Supervision shall include visual observation.

Please see LIC809D for Type A Deficiency

A Civil Penalty of $500 will be assessed during this inspection for Responsibility for Providing Care and Supervision
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 06/05/2024 12:43 PM - It Cannot Be Edited


Created By: Justin Giese On 06/05/2024 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VOLUNTEERS OF AMERICA
FACILITY NUMBER: 364820599

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2024
Section Cited

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time…
This was not met as evidenced by:
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On 05/10/2024 as Staff were transitioning children from the outdoor activity space back inside the facility, a child was left unattended outside for an estimated period of 5 minutes without supervision. This is an immediate health, safety, or personal rights risk of children in care
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LPA verified training materials and staff acknowledgements of this training. Facility met their reporting requirements by informing Licensing as well as the authorized representative of the child. A $500 civil penalty will be assessed.

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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 Sena
LICENSING EVALUATOR NAME:Justin Giese
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VOLUNTEERS OF AMERICA
FACILITY NUMBER: 364820599
VISIT DATE: 06/05/2024
NARRATIVE
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Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”.

YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

An exit interview was conducted and this report was reviewed with Site Coordinator, Gloria Delgado.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensee understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection.

A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the childcare facility and any children enrolled into the childcare facility over the next 12 months (at the time of enrollment). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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