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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700122
Report Date: 04/24/2024
Date Signed: 04/24/2024 03:08:01 PM

Document Has Been Signed on 04/24/2024 03:08 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDREN'S PARADISE INC. - MELROSEFACILITY NUMBER:
376700122
ADMINISTRATOR/
DIRECTOR:		SHAINA CORMIERFACILITY TYPE:
850
ADDRESS:145 N, MELROSE DR. STE 100TELEPHONE:
(760) 724-5600
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 87DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Shaina Cormier, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On date and time listed, Licensing Program Analyst’s (LPA’s) William Chancellor and Anastasia Flores arrived unannounced to the facility to conduct a case management visit due to an unusual incident report received in our office on April 4, 2024. The incident involved a child (C1) standing on a bucket, falling, resulting in the child breaking the arm, requiring medical attention. LPA met with Director (DIR) Shaina Cormier and conducted a tour of the facility. Appropriate ratio's and supervision were observed.

During the visit, LPA conducted interviews with five staff (S1-S5) all who were present on the day of the incident. Based on four out of five interviews, it was confirmed that C1 was climbing on a plastic storage tub that is utilized for storage of toys. C1 was climbing to reach a zip line, monkey bar that is approximately five feet from the ground. Four of five interviews additionally confirmed that children often use these bins in an inappropriate manner and will climb on top of them to reach the monkey bars. Four out of five staff interviews confirmed that there was a lack of supervision resulting in C1’s injury.

Based on interviews conducted and record review, the Department finds the facility did not ensure supervision was being met to redirect C1 from climbing on top of a plastic bin. The facility is being cited for Title 22, division 12, chapter 1, article 06; section 101229(a)(1) Responsibility for Providing Care and Supervision. Which poses a potential risk to children in care. See 809-D for cited deficiency.



An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and 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: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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 04/24/2024 03:08 PM - It Cannot Be Edited


Created By: William M Chancellor Jr. On 04/24/2024 at 01:44 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: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/24/2024
Section Cited
CCR
101229(a)(1)

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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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by …
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Director will email LPA a staff sign in and proof of staff training on playground supervsion. Including redirective strategies to ensure supervsion, safety at all times and how to use materials in age appropriate ways.
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Based on confidential interviews and record review, staff were not properly supervising C1 and did not redirect C1 from climbing on top of a plastic bin. This resulted in C1 falling and fracturing their arm, requiring medical attention.
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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:William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024


LIC809 (FAS) - (06/04)
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