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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364842819
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:12:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2023 and conducted by Evaluator Raymond Moorehead
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20231019083955
FACILITY NAME:JENSEN FAMILY CHILD CAREFACILITY NUMBER:
364842819
ADMINISTRATOR:JENSEN, ROBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 528-2986
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:14CENSUS: 7DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Robin Jensen, LicenseeTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Licensee did not provide adequate supervision resulting in inappropriate interactions between day-care children. (Supervision)
INVESTIGATION FINDINGS:
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On 01/18/2024 at 03:00 PM, Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to deliver the findings of the investigation regarding the above allegation. LPA toured the facility, took a census, and met with Licensee Robin Jensen.

During the course of the investigation, LPA conducted interviews with pertinent individuals and reviewed files/documentation.

It was reported that Licensee did not provide adequate supervision resulting in inappropriate interactions between day-care children. During the course of the investigation, it was confirmed that inappropriate interactions between the specified day-care children did occur. During pertinent interviews, it was disclosed that during outside play time children have 3 minutes to play in certain areas of the play area. Once the 3-minute timer is up, the children are to switch areas in order to allow other children to play and utilize the equipment.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 09-CC-20231019083955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JENSEN FAMILY CHILD CARE
FACILITY NUMBER: 364842819
VISIT DATE: 01/18/2024
NARRATIVE
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During pertinent interviews, it was also stated that during the 3 minutes, staff supervise children by walking around and staying outside in the play area.

Furthermore, it was also reported that the family child care home was not aware of the incident that occurred until a child told their authorized representative what happened.

During the initial complaint inspection, LPAs and LPM observed the play castle, which is where the incident occurred. It was noted that the play castle had blind spots in which you could not directly observe the children inside of it from afar. It was also observed that the play castle was moved to an off-limits area in the outdoor play area. Licensee stated that she will no longer use the play castle for children in care. Licensee also reported the incident to the Department in a timely manner.

Based on LPA observations and interviews which were conducted, and a review of additional pertinent information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

LPA informed licensee Robin Jensen that this report dated 01/18/2024 documents 1 Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health and safety to the children in care. See LIC9099-D for cited deficiency.

Also, LPA informed licensee Robin Jensen to provide a copy of this licensing report dated 01/18/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20231019083955
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JENSEN FAMILY CHILD CARE
FACILITY NUMBER: 364842819
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/19/2024
Section Cited
CCR
102417(a)
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Operation of a Family Child Care Home 102417(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times….

This requirement was not met as evidence by:


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LPAs and LPM observed that the Licensee has removed the play castle where the mentioned incident occurred. Licensee agrees to submit a written statement that demonstrates the understanding of the importance of providing adequate supervision to all children in care from herself or staff.
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Based on the complaint investigation, it was determined that the licensee/staff did not provide adequate supervision for children in care, resulting in two children conducting inappropriate interactions amongst themselves. This is an immediate risk to the health and safety to the children in care.
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Licensee agrees that the written statement will also include her plan on how she plans on providing adequate supervision for children in care moving forward. Licensee agrees to submit the plan of correction to LPA via email by 01/19/2024 by 5:00 PM. Email: Raymond.Moorehead@dss.ca.gov
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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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
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