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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846061
Report Date: 04/12/2022
Date Signed: 04/12/2022 03:33:14 PM

Document Has Been Signed on 04/12/2022 03:33 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA SIERRA ACADEMY CHILDREN'S CENTERFACILITY NUMBER:
334846061
ADMINISTRATOR:ARGUELLO, MARITZAFACILITY TYPE:
850
ADDRESS:4900 GOLDEN AVENUETELEPHONE:
(951) 351-1445
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 60TOTAL ENROLLED CHILDREN: 38CENSUS: 20DATE:
04/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maritza Arguello, Program DirectorTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Kay Phillips and Rachel Zeron conducted a case management visit at the facility in response to the receipt of two unusual incident reports (UIRs) from the facility. The UIR was received by the Department on 03/16/2022. It stated Child #1 fell on the playground and fractured their wrist.. The second UIR was received by the agency on 04/01/2022 which reported Child #2 bit Child #3 on the playground.

Upon arrival, LPAs met with facility Program Director, Martiza Arguello, and stated the purpose of the visit. The facility was toured and a census was taken. LPAs obtained information that on 03/16/2022, Child #1 was playing outside on the monkey bars when they fell. The child reported hearing a crack when they fell and tried to catch the fall by extending their arm. LPA obtained information that the child was supervised by Staff#1 while on the playground. Staff #1 immediately notified the Program Director and mother. The child was taken to the hospital and was diagnosed with a buckle fracture and placed in a soft cast. The Program Director disclosed the soft cast will be removed tomorrow. LPAs inspected the playground area was observed safe and covered with wood chips.

The second incident occurred on 04/01/2022, in which Child #2 bit Child #3 while on the playground. LPA Phillips spoke with S #2 who was supervising on the playground when the biting incident occurred. The parents of both children were contacted immediately and informed of the incident. The Program Director explained meeting with the pre-school teachers and providing intensive in-service training to assist with decreasing the biting behaviors at the facility.

No deficiencies were cited during this visit regarding the incidents at this time. An exit interview was conducted with Program Director, Maritza Arguello. A Notice of Site visit was issued and must be posted for 30 days.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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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