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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334811701
Report Date: 04/24/2024
Date Signed: 04/24/2024 02:29:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2024 and conducted by Evaluator Cindy Hamilton
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240315124302
FACILITY NAME:SJUSD-HYATT HEAD START STATE PRESCHOOLFACILITY NUMBER:
334811701
ADMINISTRATOR:ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:400 E. SHAVERTELEPHONE:
(951) 487-0526
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:108CENSUS: 74DATE:
04/24/2024
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Elizabeth ZaragozaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not meet day care child’s dietary needs.
INVESTIGATION FINDINGS:
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On April 24, 2024, at 1:10 p.m., Licensing Program Analyst (LPA), Cindy Hamilton met with SJUSD Hyatt HeadStart State Preschool (CCC) Director Elizabeth Zaragoza to deliver the findings for the above stated allegation.  During the investigation, LPA Hamilton conducted interviews with four children, five staff and the reporting party.  LPA Hamilton conducted a health and safety inspections of the CCC on March 21 and April 3, 2024, and no safety concerns were noted.  LPA obtained copies and reviewed pertinent documentation from facility and children’s records. LPA Hamilton was unable to interview the child(ren) identified as witnesses and/or “victims” due to the child(ren)’s parents denied LPA’s request to conduct interviews.

On March 15, 2024, Community Care Licensing (CCL) received information stating staff did not meet day care child’s dietary needs.  It was alleged that a child, whom has a milk allergy, was being provided with milk. Confidential interviews revealed the child was being provided milk at the CCC and CCC was not
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2024 and conducted by Evaluator Cindy Hamilton
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240315124302

FACILITY NAME:SJUSD-HYATT HEAD START STATE PRESCHOOLFACILITY NUMBER:
334811701
ADMINISTRATOR:ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:400 E. SHAVERTELEPHONE:
(951) 487-0526
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:108CENSUS: DATE:
04/24/2024
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Elizabeth ZaragozaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff handled day care child in a rough manner.
INVESTIGATION FINDINGS:
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On April 24, 2024, at 1:10 p.m., Licensing Program Analyst (LPA), Cindy Hamilton met with SJUSD Hyatt HeadStart State Preschool (CCC) Director Elizabeth Zaragoza to deliver the findings for the above stated allegation.  During the investigation, LPA Hamilton conducted interviews with four children five staff and the reporting party.  LPA Hamilton conducted a health and safety inspections of the CCC on March 21 and April 3, 2024, and no safety concerns were noted.  LPA obtained copies and reviewed pertinent documentation from facility and children’s records. LPA Hamilton was unable to interview the child(ren) identified as witnesses and/or “victims” due to the child(ren)’s parents denied LPA’s request to conduct interviews.

On March 15, 2024, Community Care Licensing (CCL) received information stating staff handled day care child in a rough manner.  It was alleged that during a coloring activity a child’s arm/wrist was grabbed roughly due to the child having too many crayons. Confidential interviews disclosed to LPA that there
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20240315124302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL
FACILITY NUMBER: 334811701
VISIT DATE: 04/24/2024
NARRATIVE
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were no witnesses to the incident and the staff involved denied handling the child roughly. In Addition, interviews with children disclosed that none of the children have been handled roughly or witnessed another child being handled roughly.

Based on confidential interviews, observations and record reviews, the allegation that staff handled day care child in a rough manner, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, appeal rights and Notice of Site Visit were provided to Director and the Director was reminded this notice must be posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 10-CC-20240315124302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL
FACILITY NUMBER: 334811701
VISIT DATE: 04/24/2024
NARRATIVE
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aware of any allergic reaction to the milk. Per records review, the CCC was provided this information December 20, 2023, at enrollment prior to the child’s attendance in January 2024 and it was also recorded that child had a dairy free diet. Also, there was a note on the Food History form that the parent completed that indicated that the child had an allergy to milk. In addition, confidential interviews also disclosed that the child’s teacher at the CCC was verbally advised of the allergy on the child’s first day of school, January 9, 2024. The same teacher was also advised of the reaction to the milk via text message on Class Dojo in January 2024. Confidential interviews disclosed to LPA that children with allergies can not start school until their medical documentation is received and a plan is in place. Confidential interview disclosed that there were multiple conversations with parent and health clerk regarding this issue prior to child being enrolled in December 2023. During the course of investigation, LPA reviewed the child’s file and observed a food history form that was submitted by the parent and was amended the same day 12/20/23 that stated that the child was eating dairy now; However, the form still indicated that the child had an allergy to milk. This form was amended by CCC.

Based on record review and confidential interviews conducted during the investigation, the preponderance of evidence standard has been met and the allegation that staff did not meet day care child’s dietary needs is substantiated. The facility is being cited for violation of Title 22 Section 101227(a)(7)(B) Food Services which poses a potential health, safety and/or personal rights risk to children in care, see LIC 809-D.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to Director and appeal rights were discussed. Director was reminded that the notice of site visit must remain posted for 30 days and that civil penalties may be assessed it this regulation is violated.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 10-CC-20240315124302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL
FACILITY NUMBER: 334811701
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2024
Section Cited
CCR
101227
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Section 101227 (a)(7)(B) Food Services (a) In childcare centers providing meals to children, the following shall apply: (7) Modified diets prescribed by a child's physician...(B) A child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement was not met as evidenced by:

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Director will provide training to all staff with assistance from RCOE regarding food allergies, communication and documentation. Director will provide proof of training to LPA via email on or before the POC due date
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Based on records review, child was served milk that child was allergic to causing child to have a reaction and this information was noted on child's Food History form dated 12/20/2023which poses a potential health, safety and/or personal rights risk to children 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.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5