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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700867
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:45:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RISE N SHINEFACILITY NUMBER:
376700867
ADMINISTRATOR:MYMIONA JOHNSONFACILITY TYPE:
850
ADDRESS:9449 WINTER GARDENS BOULEVARDTELEPHONE:
(949) 351-3644
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY:37CENSUS: 20DATE:
10/06/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Mymiona JohnsonTIME COMPLETED:
02:00 PM
NARRATIVE
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On 10/6/2021 @ 12:45PM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection. This is in reference to facility's self-report of an incident involving a staff who grabbed a child by his shoulder that left a mark.

Toured the classrooms with Mrs. Johnson. Observed present today were 20 children who were napping. These children were supervised by staff Felicia Oson & Tiffany Wilkerson.

Type A deficiency was cited today. Type A violation if not corrected, will have a direct and immediate risk to the health, safety, or personal rights of children in care.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview was conducted with Mrs. Johnson. Appeal rights were discussed. A written copy was provided today. Notice of site visit was also provided and was observed posted along with a copy of the licensing report. Notice of site visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: RISE N SHINE
FACILITY NUMBER: 376700867
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2021
Section Cited

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PERSONAL RIGHTS
To be free from corporal or unusual punishment, infliction of pain...

This requirement was not met as evidenced by:
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LPA and Mrs. Johnson reviewed a video showing what occurred between staff and child. In the video, it was observed that the staff grabbed the child by the shoulder after child bit staff. This left a mark on the child's shoulder.
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Mrs. Johnson also met with the child's parents to discuss child's biting issue. Parents are working with the child at home and are addressing his challenging behavior. Child has not bit since this incident.

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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2021
LIC809 (FAS) - (06/04)
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