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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700121
Report Date: 01/03/2020
Date Signed: 04/30/2020 12:20:17 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDREN'S PARADISE-SHADOWRIDGE INFANTFACILITY NUMBER:
376700121
ADMINISTRATOR:BRITTNEY SMITHFACILITY TYPE:
830
ADDRESS:145 NORTH MELROSETELEPHONE:
(760) 724-5600
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:32CENSUS: 13DATE:
01/03/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH: CHristina JenkinsTIME COMPLETED:
03:03 PM
NARRATIVE
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***Due to an Appeal, A citation has been changed from a Type A to Type B.

A case management visit was made today. During the course of a follow up visit Licensing Program Analyst O.Cameron observed the following Title 22 code of regulation deficiencies:

See LIC 809-D for deficiencies.

An exit interview was conducted, a copy of this report ,and appeals rights were given to the Director Christine Jenkins

A copy of this report must be made available, upon public request, for the next three years. LIC 9224 was provided along with a notice of site visit.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDREN'S PARADISE-SHADOWRIDGE INFANT
FACILITY NUMBER: 376700121
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
01/04/2020
Section Cited

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Responsibility for Providing Care and Supervision for Infants. Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. This requirement was not met

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as evidenced by: Based on observation Licensee did not ensure infants were under direct visual supervison by a staff person during todays inspection. Staff #1 was located in a separated room with 2 infants (awake) while 2 infants (napping) were in another room with the door open. .........
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No visual supervision could be made by staff with the partitioning of the room for Classroom titled CB1
This poses and immediate risk to 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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2020
LIC809 (FAS) - (06/04)
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