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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330908047
Report Date: 10/03/2023
Date Signed: 10/03/2023 04:14:05 PM


Document Has Been Signed on 10/03/2023 04:14 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 ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:RIVERSIDE COMM. COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
330908047
ADMINISTRATOR:ANTOINETTE RANGELFACILITY TYPE:
850
ADDRESS:4800 MAGNOLIA AVENUETELEPHONE:
(951) 222-8068
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:82CENSUS: 39DATE:
10/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Toni RangelTIME COMPLETED:
04:15 PM
NARRATIVE
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On the date and time listed above, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 09/22/23 and indicates a staff interacted negatively with children. An initial visit was completed on 09/27/23 at which time records were obtained and interviews conducted.

During today's visit facility records were reviewed, written statements obtained, and additional interviews conducted with pertinent parties. Facility conducted an internal investigation resulting in additional HR actions being taken and self-reporting to CDSS.

Although interviews stated children involved were not aware or in distress after interactions, interviews revealed witnessing a staff use a cold and harsh tone, yank sleeping children’s blankets to wake children up, and lift a sleeping child by the arm to retrieve a nap mat.



Based on the information gathered, the following violations have been identified:
CCR 101223 (a) (3) Personal Rights - (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Division 12.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to facility representative, Toni Rangel.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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 10/03/2023 04:14 PM - It Cannot Be Edited

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 ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: RIVERSIDE COMM. COLLEGE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 330908047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
101223(a)(3)

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101223 (a) (3) Personal Rights: 3)To be free from corporal or unusual punishment, ... but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.This requirement is not met as evidenced by:
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Facility will complete training on personal rights with staff and submit materials and attendance sheet to the department by POC due date 10/13/23.
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Based on interviews conducted the facility did not meet the section cited above in that children were not free from interference with functions of daily living. This poses a potential health, safety, or personal rights risk to persons 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: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2