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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844562
Report Date: 05/17/2024
Date Signed: 05/17/2024 10:49:24 AM

Document Has Been Signed on 05/17/2024 10:49 AM - 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:HEMET ELEMENTARY PRESCHOOLFACILITY NUMBER:
334844562
ADMINISTRATOR/
DIRECTOR:		MELINA SERNAFACILITY TYPE:
850
ADDRESS:220 S. FRANKLIN ST.TELEPHONE:
(951) 765-1648
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY: 106TOTAL ENROLLED CHILDREN: 106CENSUS: 19DATE:
05/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Melina Serna TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On May 17, 2024, at 09:35 AM, Licensing Program Analyst (LPA) Anastasia Flores arrived unannounced to the facility to conduct a case management visit due to an unusual incident report received in our office on May 10, 2024. The incident involved a child (C1) leaving the gated entrance to the school without supervision. LPA interviewed the teacher, present on the day of the incident that occurred on 4/30/24. It was confirmed that C1 walked out of the gate without staff’s knowledge, another parent witnessed C1 walking without a parent or staff. Parent of C1 observed C1 walking away from the building to the left of the gate, questioned staff why C1 was outside of the gate without supervision.

Based on interviews conducted and record review, the Department finds the facility did not ensure supervision was being met resulting in C1 leaving supervision of staff and without being properly signed out for about a minute. The facility is being cited for Title 22, division 12, chapter 1, article 06; section 101229(a)(1) Responsibility for Providing Care and Supervision. Which poses an immediate risk to children in care. See 809-D for cited deficiency.

An exit interview was conducted, a copy of this report, appeal rights, were reviewed with and provided to Preschool Principal/Director, Melina Serna.



The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00
If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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 05/17/2024 10:49 AM - It Cannot Be Edited


Created By: Anastasia Flores On 05/17/2024 at 10:30 AM
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: HEMET ELEMENTARY PRESCHOOL
FACILITY NUMBER: 334844562

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1)Responsibility for Providing Care and Supervision; The licensee shall provide care and supervision as necessary to meet the children's needs. 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 was not met as evidenced by…
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Preschool program has changed the dismissal protocal with the children in care. Director will send LPA Flores a letter with the plan of correction that was made prior to the visit on 05/17/24, to be placed in the facility file by 5/24/24.
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Based on record review and interviews, child #1 was out of visual observation from the teachers for at least one to two minutes. This poses an immediate health and safety risk to the 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.
SUPERVISOR'S NAME:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
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