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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846109
Report Date: 03/20/2024
Date Signed: 03/20/2024 01:38:43 PM

Substantiated


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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2024 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240306140913
FACILITY NAME:TRF ALL SAINTSFACILITY NUMBER:
334846109
ADMINISTRATOR:MEJICO, DANETTEFACILITY TYPE:
830
ADDRESS:3847 TERRACINA DRIVETELEPHONE:
(310) 420-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:32CENSUS: 19DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jacqueline HinojosaTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff did not prevent child from harming another child in care
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to investigate the above complaint received on 03/06/2024. An initial visit was conducted on 03/07/24, at which time LPA conducted interviews and reviewed records. LPA was given access to the facility by the Director, Jacqueline Hinojosa. LPA discussed purpose of visit, took census, and toured the facility. LPA met with the Director to further discuss the complaint allegations and deliver findings.
It was alleged staff did not prevent a child with known behaviors of harm to others from injuring another child. During the investigation, LPA interviewed all pertinent parties, including facility staff, and reviewed records.
Pertinent party interviews stated there is a child that engages in unprovoked grabbing, pinching, pushing, and scratching of other children. Interviews disclosed the child makes several attempts to harm others and is successful approximately1-2 times per day resulting in need for first aid and ouch reports for various children. Additionally, interviews reported management has been notified of behavioral concerns;
however, no plan of action for behavior interventions, parent conferences, or training resources have been
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 3
Control Number 09-CC-20240306140913
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: TRF ALL SAINTS
FACILITY NUMBER: 334846109
VISIT DATE: 03/20/2024
NARRATIVE
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implemented. Interviews reported staff verbally redirect daily and when they can, shadow the child, but shadowing is not consistent.
LPA reviewed the following records: incident reports, photos, parent handbook and medical documentation. A sampling of eighteen incident reports from December 2023 - March 2024 revealed a child harmed several children, and shadowing occurred once. Photos obtained showed on 02/29/24, a child sustained scratches on their temple, side/cheek, neck and under the eye. Medical documentation dated 02/29/24 corroborated additional first aid treatment to treat cuts and scratches to child’s facial area. Facility’s parent handbook (page 20) notes a parent conference is to be conducted for children with reoccurring behaviors to discuss a plan of action and/or dismissal for a child’s actions that are dangerous to others; as of the initial visit date neither action had been taken.

Based on interviews conducted and documentation reviewed, the Department has determined the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED, per California Code of Regulations, Title 22, Division 12.

See LIC9099D for deficiency cited.

LPA Carbullido informed licensee/facility representative (Director), Jacqueline Hinojosa that this report dated 03/20/2024 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Carbullido informed the facility representative to provide a copy of this licensing report dated 03/20/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, and appeal rights were discussed. A copy of this report and Notice of Site Visit were provided to the Director, Jacqueline Hinojosa and the LPA observed posting of the Notice of Site Visit form by the Director. THIS REPORT MUST BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20240306140913
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: TRF ALL SAINTS
FACILITY NUMBER: 334846109
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2024
Section Cited
CCR
101223(a)(2)
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101223(a)2) Personal Rights To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidence by:
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Facility will schedule a parent conference as required by facility and noted in Parent Handbook. Facility will also schedule a staff meeting to identify interventions including staffing of the plan and/or interventions to be used by POC due date 03/21/24.
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Based on LPA’s record review , staff and Parent interviews the Licensee/facility did not comply with the section cited above in that several children were not provided safe and healthful accomodations when injured by a child's harmful behaviors resulting in need for first aid/medical evaluation. This is an immediate risk to the health and safety of 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.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
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