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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701308
Report Date: 05/15/2019
Date Signed: 05/15/2019 12:47:51 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:MAAC FOOTHILL INFANT CENTERFACILITY NUMBER:
376701308
ADMINISTRATOR:APRIL ANDREOLAFACILITY TYPE:
830
ADDRESS:1410 FOOTHILL DRIVETELEPHONE:
(760) 741-0541
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:20CENSUS: 11DATE:
05/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:April Andreola- DirectorTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sean Williams arrived at the facility, for the purpose of conducting a Case Management follow-up visit; regarding an unusual incident report that was submitted by the facility on June 13, 2018. LPA met with Director April Andreola, to discuss the reported incident. LPA took census, conducted interviews, reviewed documentation and toured the facility where the incident took place.

The reported incident is regarding absence of supervision that occurred on May 08, 2019. When the incident occurred there were 5 infant children in care under the supervision of Staff #1 and Staff # 2 . At approximately 10:00 AM Staff #1 and Staff # 2 were escorting children from the classroom to the play ground. During the escort, it was reported that one of the children ran out to the playground gate. It was reported that Staff #1 ran after the child, while the other children continued to follow Staff # 2 to the playground. After Staff # 1 retrieve the child that ran, Staff # 1 proceeded to escort the child to the playground with the other children. During that time, Staff # 3 found another child that was left behind in the classroom, alone without supervision. Staff # 3 then escorted the child out to the playground with the other children. It was reported that Staff # 1 assumed all the children went out to the playground with Staff # 2 while the child was being retrieved. It was reported that the facility director notified the parent of the child, in the process of providing supervision training for all staff members, and adjusted the transition schedules. This adjustment was made to avoid this type of incident from occurring again. The following day, the facility Director April Andreola submitted an unusual incident report to Community Care Licensing outlining the incident.

Based on the interviews and information obtained during the visit, there was a violation of Title 22 Regulations, as an infant was left in the classroom unattended. (SEE LIC809D) for citation:

101429 Responsibility for Providing Care and Supervision for Infants. (a) In addition to Section 101229, the following shall apply: (1) 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.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-0203
LICENSING EVALUATOR NAME: Sean R WilliamsTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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: MAAC FOOTHILL INFANT CENTER
FACILITY NUMBER: 376701308
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2019
Section Cited
CCR
101429(a)(1)
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101429 Responsibility for Providing Care and Supervision for Infants.
(a) In addition to Section 101229, the following shall apply:
(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
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Director agrees to implement a new policy for lead teachers to be present during trasition periods with the children. A head count and name to face of each child will be done upon entering and exiting the classroms.
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Under no circumstances shall ANY infant be left unattended. This requirement was not met due to:

On May 08,2019 facility staff leaving an infant in the classroom without supervision.This action put the child in immediate danger.
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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) 320-0203
LICENSING EVALUATOR NAME: Sean R WilliamsTELEPHONE: (951) 782-4951
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
LIC809 (FAS) - (06/04)
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