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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334819985
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:31:53 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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2024 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240422123250
FACILITY NAME:MELODY LANE CHILDREN'S CENTERFACILITY NUMBER:
334819985
ADMINISTRATOR:JULIE BACAFACILITY TYPE:
850
ADDRESS:9191 COLORADO AVENUETELEPHONE:
(951) 352-2161
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:73CENSUS: 23DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Julie BacaTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to a daycare child
Staff verbally abused another staff in front of daycare children
Staff yells at the daycare children while in care
Staff demonstrates inappropriate form of discipline
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to investigate the above complaint received on 04/22/24. An initial visit was conducted on 04/24/24 at which time LPA conducted interviews and reviewed records. LPA was given access to the facility by the Director, Julie Baca. LPA discussed purpose of visit, took census; toured the facility and conducted additional interviews. LPA met with the Director to further discuss the complaint allegations and deliver findings.
It was alleged staff did not provide adequate supervision to a daycare child. During the investigation, LPA interviewed all pertinent parties, including facility staff.
Pertinent party interviews reported during transition from outdoor activity to the bathroom prior to lunch, the first class left a child in a bathroom stall and the 2nd class transitioning afterwards found the child and notified the first classes’ staff and management.
It was alleged staff verbally abused another staff in front of daycare children. During the investigation, LPA interviewed all pertinent parties, including facility staff
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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 4
Control Number 09-CC-20240422123250
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334819985
VISIT DATE: 05/03/2024
NARRATIVE
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Pertinent party interviews reported a staff occasionally yells, including a self-admission for raising voice,
and identified a recent incident in which a staff yelled at another staff in front of children resulting in the children appearing confused and asking why the staff is being yelled at.
It was alleged staff yells at the daycare children while in care and demonstrates inappropriate form of discipline.
During the investigation, LPA interviewed all pertinent parties, including facility staff and children. Pertinent parties reported teaching children social skills for redirection and allowing time to refocus. Staff interviews stated voices may be raised in a loud, animated or firm voice for redirection in the classroom, on the playground for safety or in the office for on-going behaviors. Children interviews stated they have heard yelling, have cried themselves or seen other children cry after going to the office to speak with staff when they don't listen and get into trouble.

Based on interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED per California Code of Regulations, Title 22, Division 12 . See LIC9099D for cited deficiencies; a civil penalty has been assessed in the amount of $500.00.
If a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA Carbullido informed facility representative Julie Baca that this report dated 05/03/24 document(s) (2) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Carbullido informed the facility representative Julie Baca to provide a copy of this licensing report dated 05/03/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Appeal rights issued and discussed with licensee and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the Director, Julie Baca. THIS REPORT DOES HAVE TO BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 09-CC-20240422123250
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334819985
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/04/2024
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility for Providing Care and Supervision (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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Facility Director agrees to submit proof of signed acknowledgment(s) (LIC9224's) and staff in-service training on CCR regulation 101229(a)(1) to the department by POC due date 05/04/24. AN IMMEDIATE CIVIL PENALTY HAS BEEN ASSESSED FOR $500.00.
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Based on interviews conducted, the licensee did not comply with the section cited above in that the facility did not maintain supervision of all children resulting in a child being left unsupervised in the bathroom which poses an immediate health, safety or personal rights risk to persons in care
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Type A
05/04/2024
Section Cited
CCR
101223(a)(1)
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101223(a)(1) Personal rightsTo be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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Facility will submit inservice training and attendance regarding child/staff interactions on personal rights CCR regulation 101223(a)(1) by POC due date 05/04/24.
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Based on interviews conducted the licensee did not comply with the section cited above in that children stated they have seen others crying or cried themselves when redirected ( disciplined) in the office which poses an immediate 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: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 09-CC-20240422123250
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334819985
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
101223(a)(2)
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Personal rights: 101223(a)(2)-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Facility will submit inservice training materials and staff attendance on safe and healthful accomodations per personal rights CCR regulation 101223(a)(1) by POC due date 05/10/ 24.
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Based on interviews conducted the licensee did not comply with the section cited above in that children observed a staff yelling at another staff which 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: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4