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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330908048
Report Date: 09/17/2024
Date Signed: 09/17/2024 02:36:19 PM

Document Has Been Signed on 09/17/2024 02:36 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MT. SAN JACINTO COLLEGE CHILD DEVELOPMENTFACILITY NUMBER:
330908048
ADMINISTRATOR/
DIRECTOR:		KIMBERLY DAYFACILITY TYPE:
850
ADDRESS:1499 N. STATE STREETTELEPHONE:
(951) 487-3613
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 124TOTAL ENROLLED CHILDREN: 62CENSUS: 37DATE:
09/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:26 PM
MET WITH:Kendra WoodcockTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On September 17, 2024, at 12:30 PM, Licensing Program Analysts (LPAs) Cindy Hamilton and Brian Morris arrived at the facility on a case management visit to follow-up on an unusual incident report (UIR) submitted by the facility on 8/30/2024. At the time of visit, LPAs toured the facility, took census, and met with Director – Kendra Woodcock to discuss the reported incident. The children involved in the incident were not interviewed by the LPAs.

The UIR documented an incident on 08/30/24, when two children allegedly engaged in inappropriate behavior between themselves while in the classroom when Child #1 allegedly touched Child #2’s bottom, private area and kissed C2 on the mouth. It was also stated that C1 pulled C2’s pants down. The alleged inapproprite behavior was not witnessed by any of the staff or children present. Interviews disclosed to LPA that the appropriate ratio and supervision was being provided by staff. When the classroom staff was made aware of the alleged incident, staff immediately spoke to the children about inappropriate behavior and how the behaviors were inappropriate. However, it was disclosed that staff did not advise the director or parent of C1 or C2 of the alleged incident prior to the child being dismissed and parent contacting the facility regarding the alleged incident.

Based on the information gathered, facility failed to comply with Reporting Requirements per regulation section 101212 (f), which specifies: (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

See LIC809-D for cited deficiency.

An exit interview was held with Director – Kendra Woodcock and a copy of this report, appeal rights and Notice of Site visit was issued. Director was reminded that the notice of site visit must remain posted for 30 days. This report shall be public record for three years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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 09/17/2024 02:36 PM - It Cannot Be Edited


Created By: Cindy Hamilton On 09/17/2024 at 02:17 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: MT. SAN JACINTO COLLEGE CHILD DEVELOPMENT
FACILITY NUMBER: 330908048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2024
Section Cited
CCR
101212(f)

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101212 (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirement has not been met as evidenced by:
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Director stated there will be a staff meeting on 9/27/2024 and training will be provided on Personal Rights, Policies and Regulations, boundaries and proper reporting procedures. In addition, there will be training provided by risk managment in late October on the above and parent reporting. Director will provide LPA training content, agenda and sign in sheets for both trainings on or before POC due date via email or USPS.
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Based on interviews and records review it was disclosed that the parent of C2 was not advised of the alleged incident by facility staff which poses a potential health, safety and/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:Carlos Martinez
LICENSING EVALUATOR NAME:Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024


LIC809 (FAS) - (06/04)
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