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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700122
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:26:07 PM

Document Has Been Signed on 11/16/2022 02:26 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDREN'S PARADISE INC. - MELROSEFACILITY NUMBER:
376700122
ADMINISTRATOR:SHAINA CORMIERFACILITY TYPE:
850
ADDRESS:145 N, MELROSE DR. STE 100TELEPHONE:
(760) 724-5600
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 81DATE:
11/16/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Shania CormierTIME COMPLETED:
02:45 PM
NARRATIVE
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On November 16, 2022 at 2:00 pm, Licensing Program Analyst (LPA), Jessica Rubio met with Children’s Paradise Melrose (CCC), Director (AD), Shaina Cormier to discuss an unusual incident that was not reported timely to Community Care Licensing (CCL). CCC was made aware of an allegation of inappropriate behavior between C1 and C2 on 9/19/2022. The CCC reported the unusual incident to CCL on 10/10/2022, only after CCC was informed a Child Protective Services report would be filed. The facility is being cited for Title 22 Regulation Section 101212 (d)(1)(C). An exit interview was conducted, and a copy of this report was provided to Director Shaina Cormier. A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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 11/16/2022 02:26 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 11/16/2022 at 01:49 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDREN'S PARADISE INC. - MELROSE
FACILITY NUMBER: 376700122

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/23/2022
Section Cited
CCR
101212(d)(1)(C)

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Upon the occurrence.. of any of the events specified in (d)(1) below, a report shall be made to the Department...within...next working day. Events reported shall include...Any unusual incident ..that threatens the physical or emotional health or safety of any child.
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Director stated they will put a plan in place regarding reporting unusual incidents to CCL and provide to LPA.
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This requirement was not met as evidenced by:
Based on interviews and record review there was a delay in CCC reporting the alleged inapproporiate incident between C1 and C2, which poses a potential, heath, safety or personal rights 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


LIC809 (FAS) - (06/04)
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