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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842375
Report Date: 05/29/2024
Date Signed: 05/29/2024 01:57:46 PM

Document Has Been Signed on 05/29/2024 01:57 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:VVUSD MEAD VALLEY ELEMENTARYFACILITY NUMBER:
334842375
ADMINISTRATOR/
DIRECTOR:		ANDREA RODICH-VITEKFACILITY TYPE:
850
ADDRESS:21100 OLEANDER AVENUETELEPHONE:
(951) 940-8530
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 25DATE:
05/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Andrea Rodich-VitekTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 05/23/24 from the facility stating an incident that occurred in Room 6.

LPA conducted interviews with pertaining parties, and it was found that on Monday, 05/13/24 S1 smashed the toy phones using a hammer in front of the children. During the morning session, as per Staff 1(S1) children were ‘bickering and fighting’ over the shared use of the toy phones. S1 retrieved a hammer from the drawer which is located in the classroom and smashed the toys. Child 1 (C1) shared this incident with their parent who reported it to the school administration. There were 18 students present in Room 6 on the day of the incident and 2 assistants.

C1 does not attend the facility anymore due to the incident and the last day of attendance was of 05/13/24.

From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101223(a)(3) Personal Rights.



See LIC 809D for deficiencies cited.

An exit interview was conducted with the Facility Representative Ms. Andrea Rodich-Vitek, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 05/29/2024 01:57 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 05/29/2024 at 01:04 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: VVUSD MEAD VALLEY ELEMENTARY
FACILITY NUMBER: 334842375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2024
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, … humiliation, intimidation… threat, or other actions of a punitive nature… to physical functioning.
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The Facility Director agrees to review Title 22 section Personal Rights with Staff 1. The Facility Director will provide a copy of the written plan for staff 1 to the Department by the due date.
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This requirement was not met as evidenced by: Based on interviews S1 smashed the toy phones in front of the childcare children to stop their fighting over the shared toy phones using a real hammer.
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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:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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