364840979-5-8-2019-09-CC-NZUA-BBYUTZ-20190508155247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364840979
Report Date: 05/08/2019
Date Signed: 05/08/2019 03:53:33 PM

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:	OMSD/SULTANA ELEMENTARY SCHOOL		FACILITY NUMBER:	364840979
ADMINISTRATOR:	MOLINA, CARA		FACILITY TYPE:	850
ADDRESS:	1845 S SULTANA AVENUE		TELEPHONE:	(909) 459-1215
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91761
CAPACITY:	24	CENSUS: 24	DATE:	05/08/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Brenda Mason		TIME COMPLETED:	04:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Nelson Zuniga 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 on 04/10/19, date of incidents 04/9/19. The UIR indicated that there was an alleged possible personal rights violation and lack of supervision, it stated that approximately 3:00 pm a child left the classroom at dismissal and walked one block down the sidewalk to the intersection of Francis Avenue and Sultana Avenue. The following is learned: The classroom has three staff members and is situated where the back door of the classroom leads to the fenced children playground. The playground has a gate that leads to the school front parking lot and to the main street, Sultana Avenue. At dismissal time, parent line up on the sidewalk along the outside playground fence. Parent are met by the first staff at the gate, parents provide the name of the child that they are there to pick up. The first staff person lets a second staff person know the name of child. This second staff person is standing by the door of the classroom and playground. Second staff person lets the third staff person know name of child, third staff person calls child and lets child get up and go to door where the second staff person is situated. Second staff person sends child to the gate, where the first staff person is located. On 4/9/19 the dismissal process was not follow as mentioned above. On this day there were three substitute, Staff #1, 2, and 3. The regular/permanent staffs had scheduled training and were released by the three substitutes. The regular/permanent staffs did not review with substitutes the dismissal process, per permanent staffs the substitutes had been at this site before and should have known the dismissal process. (Continue on LIC809C)

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Nelson Zuniga	TELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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: OMSD/SULTANA ELEMENTARY SCHOOL	FACILITY NUMBER: 364840979
	VISIT DATE: 05/08/2019

NARRATIVE

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Instead, on this day, there were two staffs, staff #1 and 2 inside the classroom and staff #3 outside by the door that leads to the playground. Also on this day, there was a birthday celebration as the children were leaving a parent who was at one of the tables in the playground, had brought treats for the children in care. Staff #3 left her station because she could not locate the emergency information for a child to verify who the person was that was picking up that child. Staff #3 came inside classroom and asked staff #2 where the emergency information folder was. Staff #1 and #2 began to help staff #3 and look for the folder. It is uncleared whether it was at this time that Child #1 was able to leave classroom. Walk out of the classroom, through the back door that leads to the playground. Walked out of the gate that leads to the school front parking lot and Sultana Avenue. Child #1 walked along the sidewalk, next to the front school parking lot. Turned north on Sultana Avenue heading towards Francis Avenue.
An adult, Adult #1 recognized child #1 walking alone, along the sidewalk on Sultana Avenue halfway to the intersection of Francis Avenue. Adult #1 knew child #1 because adult #1 has a relative who attends the preschool, Child #2. Adult#1 stopped the vehicle, pulled to the side of street, adult #1 and Child #2 called Child #1 name, to come to vehicle. Adult #1 asked child #1 why Child #1 was walking alone on the street and where was he going. Child #1 did not have an answer and per adult looked confused. Adult #1 and Child #2 asked Child #1 to get in the vehicle, which Child #1 did. Adult #1 returned child to the classroom.
Neither of the three staff persons at the preschool were aware that child # 1 had left classroom and school grounds.
This is a ZERO TOLERANCE violation and no immediate civil penalty of $500.00 will be assessed due to school district being exempt.
Based on the information gathered, there is a violation pertaining to the UIR and the following violations have been identified: Per California Code of Regulations, Title 22, Division 12., Lack of Supervision. See LIC 809D for cited deficiencies. An exit interview was conducted, appeal rights discussed and provided, and a copy of this report was provided to representative. Notice of Site Visit was provided

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Nelson Zuniga	TELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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: OMSD/SULTANA ELEMENTARY SCHOOL	FACILITY NUMBER: 364840979
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/09/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual observation. This requirement was not met as evidence by: On 4/9/19 at dismissal time	1 2 3 4 5 6 7	and returned child to preschool. The three staff members were unaware that child had left the classroom and walked out of the school grounds. This poses a health and safety risk to the children in care.
	8 9 10 11 12 13 14	a child left the classroom alone, to the playground, left the playground, to the sidewalk along the front of school parking lot, turned north on Sultana Ave., towards Francis Ave., an adult, who has a relative in care at facility reconignized child walking alone. Asked child to get in vehicle CONTINUE.....	8 9 10 11 12 13 14	Licensee states: All staff will be trained in supervision and accountability. In addition, staff will be receiving new dismissal procedures to include every time a substitute is being used, permanent staff will have to review procedures with substitutes prior to working at that particular site. Licensee will provide proof to licensing agency.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Nelson Zuniga	TELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

LIC809 (FAS) - (06/04)

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