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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843061
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:14:29 PM


Document Has Been Signed on 11/22/2022 03:14 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:FOOTHILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364843061
ADMINISTRATOR:PAULINE COPASFACILITY TYPE:
840
ADDRESS:791 E. FOOTHILL BLVD. UNIT BTELEPHONE:
(909) 985-4448
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:71CENSUS: 48DATE:
11/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Pauline CopasTIME COMPLETED:
03:15 PM
NARRATIVE
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On 11/22/22 a follow up case management inspection is being conducted by License Program Analysts (LPAs) Blanca Ruiz and Elyse Jones in response to an unusual incident report (UIR) from the facility. LPAs met with Director, Pauline Copas.  The center was toured, and a census was taken. During the process of the investigation, records were reviewed and interviews were conducted with pertinent parties. UIR indicates that the Personal Rights of two children were violated by another child during an offsite  activity organized by the facility. Incident(s) occurred in one of more occasion on the same day. The facility conducted an internal investigation upon having knowledge of the incident. Parent(s)/Legal guardian(s) of children were informed of incident(s). Children involved are still attending the facility. Per Director, staff denied observing the incident(s); however, information obtained from pertinent parties confirmed the Personal Rights violation.

Based on the information gathered, the following violation has been identified: 101223 (a)(1)Personal Rights
(a)The licensee shall ensure that each child is accorded the following Personal Rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. See LIC 809D for cited deficiency cited of the California Code of Regulation, Title 22, Div. 12.  An exit interview was held with Director, Pauline Copas.
A Notice of Site visit was issued and shall remain posted for the next 30 days.  Appeal rights (LIC9058 12/2015) were provided and discussed during this inspection. The signature on this report acknowledges receipt of those rights.  A copy of all Type A  deficiencies (LIC 809D)cited during this inspection must be also posted for 30 days. LIC 9224 was provided to obtain signature(s) and a copy of all Type A  deficiency cited during this inspection must be also be immediately (within 24 hours of the child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months.

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: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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 11/22/2022 03:14 PM - 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: FOOTHILL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364843061

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/23/2022
Section Cited

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(a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by: Personal Rights/ dignity of two children were violated by another child during an offsite activity
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organized by the facility. Incident(s) occurred in one of more occasion, in the same day. Children are still attending the facility. This poses an immediate risk to the health and safety and Personal Rights of children in care.

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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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