334841758-2-1-2023-10-CC-PBER-CNVTL7-20230209134903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334841758
Report Date: 02/01/2023
Date Signed: 02/01/2023 10:21:54 AM

Unsubstantiated

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
01/24/2023 and conducted by Evaluator Anastasia Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20230124144029

FACILITY NAME:	FSA-HEMLOCK CDC		FACILITY NUMBER:	334841758
ADMINISTRATOR:	ANA AGUIRRE		FACILITY TYPE:	830
ADDRESS:	23270 HEMLOCK AVENUE		TELEPHONE:	(951) 243-3192
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	25	CENSUS: 18	DATE:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Ana Aguirre		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not sanitizing toys
Facility staff are not laundering linens
Facility is in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On February 1, 2023, at 46 AM, Licensing Program Analyst (LPA) Anastasia Flores, arrived for the purpose of delivering the findings on the above stated allegations. On December 21, 2022, at 9:54 AM, LPA conducted a health and safety inspection of the facility, and no immediate concerns were noted. Copies of work orders, emails and photos were obtained. Interviews were conducted with six staff (S1, S2, S3, S4, S5, S6).
On December 16, 2022, this agency received allegation that facility staff are not sanitizing toys in the toddler classroom. Confidential interview disclosed the staff were not properly cleaning the toys during the day and no witness of the toys the children mouthed being sanitized until the end of the day. Interview with five out of six staff stated the toys the children put in their mouths are placed in a container on top of the cabinet, out of children’s reach and cleaned during nap time with bleach and water.
On December 16, 2022, this agency received allegation that facility staff were not laundering the linens in the toddler and infant classroom. Confidential interviews disclosed that sheets the children sleep on are rolled up and placed back into their cubbies and not washed daily.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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 2

Control Number 10-CC-20230124144029

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: FSA-HEMLOCK CDC	FACILITY NUMBER: 334841758
	VISIT DATE: 02/01/2023

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
26
27
28
29
30
31
32

Interview with facility Director stated the facility staff alternate who washes the sheets and it is noted on the calendar in the Director’s office. Other confidential interviews denied observing the sheets being washed, witnessing the sheets placed back into the child’s cubby after nap time. Interview with three staff disclosed the children’s sheets are washed at the end of each business day.

On December 16, 2022, this agency received allegation that facility is in disrepair. Confidential interviews disclosed that the facility had chipped paint on the baseboards, broken fencing on the playground and a sink in the toddler room that was broken and continued to be clogged while in use. On 12/21/22; LPA Flores observed there to be a broken sink in the toddler room the children had been utilizing and full of water. Interview with facility Director, disclosed that a work order has been placed and maintenance has come and cleared the sink on at least two other occasions. Interview with three out of six staff disclosed that the sink is blocked off for the children not to use when the sink is clogged. Records received disclosed that a maintenance order has been placed on 7/06/22 and 9/16/22. Facility Director has placed an additional work order to have the sink fixed.

Based on interviews and record review the allegations are unsubstantiated meaning that although the allegations may have happened or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations that facility staff are not sanitizing toys, facility staff are not laundering linens and facility is in disrepair are unsubstantiated.

An exit interview was conducted and copy of this report, appeal rights and Notice of Site Visit were provided to licensee. Licensee was reminded that the Notice of Site Visit must be posted in the facility in a visible area for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2