198014650-10-8-2024-33-CC-SLII-D9UQBW-20241008120214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014650
Report Date: 10/08/2024
Date Signed: 10/08/2024 12:02:24 PM

Document Has Been Signed on 10/08/2024 12:02 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	RANCH HILLS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	198014650
ADMINISTRATOR/ DIRECTOR:	JAIME LE		FACILITY TYPE:	850
ADDRESS:	2 TRABUCO PLACE		TELEPHONE:	(909) 397-4912
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 16	CENSUS: 9	DATE:	10/08/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:05 AM
MET WITH:	Lead Teacher Arlene Franco		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced Case Management inspection due to an incident that occurred on 10/1/24 and was reported to the Department on 10/2/24. A COVID risk assessment was conducted. LPA met with Lead Teacher Arlene Franco to whom the reason for the visit was explained. Teacher guided LPA on a tour of the facility. There were 9 children present and 4 staff. Program is a partnership program and has a blended class of general Ed and special Ed students. The facility was observed to be operating within the license capacity limitations. On October 2, 2024, an unusual incident report was made to the Department regarding an injury that occurred during Am outdoor playtime. Child is a 4 year old special needs student with physical development delays. Child had gotten off the rock climbing wall on the play structure and walked towards the water table. When child reached the table, her right ankle buckled under her weight and she fell forwards hitting her chin on the edge of the table resulting in biting down on her tongue. Teachers observed her walk the entire way and no hazards were in her way. Teachers called mother immediately while other teacher assisted with the child. Emergency responders were called due to being unable to assess the injury right away from the blood and CDC supervisors were contacted regarding the incident. Paramedics are mother arrived within minutes and the bleeding had slowed down by the time they arrived. Per teacher, paramedics were able to assess her injury upon arrival. Paramedics felt that child might need stitches and advised to go to the hospital. Mother went with child to hospital in ambulance. Mother followed up with child development nurse. Child sustained a gash in the center right of her tongue (1 ½ cm long) due to biting on fall. Child did not need stitches. Doctor advised for wound in mouth to heal on its own. Per teacher, mother has been in contact to update center of child’s injury. Mother has reported that child’s tongue has been healing quickly. Mother sent photos to CDC school nurse. During today’s visit, teacher has request documents of the follow up records from the nurse. Child stayed home after injury and returned to school yesterday 10/7/24. Per doctors instructions, mother asked for teachers to serve soft foods and avoid anything hard or crunchy for snacks. *Continued on next page

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RANCH HILLS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198014650
	VISIT DATE: 10/08/2024

NARRATIVE

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During todays visit, LPA interviewed teacher, students start day was 9/9/24, took photos of the area child was playing and area she fell. LPA obtained records pertaining to the UIR, nurses summary, and a copy of students IEP. IEP indicates that child has a diagnosis of FOX P1 Syndrome (an autosomal neurodevelopmental disorder) and a right hip subluxation. Report also shows that child has worn cast on her legs and had surgery on her hips.

Per IEP, occupational therapy notes state that child has had 2 surgeries to correct a right femur subluxation with spica cast rehabilitation. Child is still receiving rehabilitative services and is gradually getting stronger.

Based on information obtained during this investigation, no additional follow up is necessary regarding the incident reported. No deficiencies are being cited at this time.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Lead Teacher Arlene Franco.

*End

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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