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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845630
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:18:58 PM

Document Has Been Signed on 01/08/2025 03:18 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MARIPOSA PARENT CHILD WORKSHOPFACILITY NUMBER:
334845630
ADMINISTRATOR/
DIRECTOR:		MARIA LARAFACILITY TYPE:
840
ADDRESS:47192 MONROE STTELEPHONE:
(760) 342-7400
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 30TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
01/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:49 PM
MET WITH:Director Maria Lara TIME VISIT/
INSPECTION COMPLETED:
03:28 PM
NARRATIVE
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On 1/8/2025 at 1:49pm, Licensing Program Analysts (LPAs) Jeanette Sanchez and Naomi Hurtado arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 1/3/2025. It indicates that a child sustained a broken right wrist on 12/30/2024, after falling off of a yellow playground structure. LPAs met with Director Maria Lara.

LPAs toured facility and conducted interviews. Director, S1 and S2 were present with a total of 16 children. C1 and C2 were sitting on top of a yellow crawling tube, facing opposite directions. The children were described as talking and laughing. Due to the manner in which they were sitting, they had to slightly turn to look over their shoulders when they were talking. Director heard S1 tell the children to be careful. Director looked in their direction and saw the children falling off of the structure. The structure measures 3 feet, 3 inches from top to the ground. C1 was taken to the classroom by S1, while Director called the parents.

LPA Sanchez asked Director if she knows the intended use for the structure or the age range that is indicated for that structure. Director said the facility does not have that information due to the equipment already being present when they moved in. LPA completed an online search and found similar products with age range 2-5, with the intended purpose being crawling through the tunnel.

Due to the equipment being used in a manner for which it was not intended and an age range for which it was not intended, C1 was injured. Also, staff did not redirect children to get off of the structure, therefore did not provide supervision to meet the children's needs. See LIC809-D for cited deficiency.

An exit interview was conducted, and this report was reviewed with the facility representative Maria Lara. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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 01/08/2025 03:18 PM - It Cannot Be Edited


Created By: Jeanette Sanchez On 01/08/2025 at 03:07 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: MARIPOSA PARENT CHILD WORKSHOP
FACILITY NUMBER: 334845630

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
101229(a)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
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Facility will research the playground equipment to find the age ranges and intended use. Facility will submit a statement to department with the information and a plan to prevent future incidents. Facility will also have a meeting regarding proper use of equipment and supervision.

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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:Deborah Mullen
LICENSING EVALUATOR NAME:Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
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