334846109-6-22-2023-09-CC-GCAO-CT2V7N-20230622161125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846109
Report Date: 06/22/2023
Date Signed: 06/22/2023 04:11:30 PM

Document Has Been Signed on 06/22/2023 04:11 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:	TRF ALL SAINTS		FACILITY NUMBER:	334846109
ADMINISTRATOR:	MOSLEY, DR. KEENA RUSH		FACILITY TYPE:	830
ADDRESS:	3847 TERRACINA DRIVE		TELEPHONE:	(310) 420-1025
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 15	DATE:	06/22/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Danette Mejico		TIME COMPLETED:	04:15 PM

NARRATIVE

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On the date and time listed above, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 06/07/2023. It indicates mis-communication between staff and parent resulted in a child entering the facility parking lot unsupervised.

Facility records were reviewed, and interviews were conducted with the Program Director, Teachers, Office Staff and Parent. All interviews reported large exit gate to the parking lot was left wide open and no formal communication releasing child to parent occurred. Based on the information gathered, the following violations have been identified:

CCR 101229(a)(1)
Responsibility for Providing Care and Supervision (1) 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.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Division 12. An immediate $500.00 civil penalty has been assessed.

IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/22/2023

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LPA Carbullido informed licensee facility representative] Danette Mejico that this report dated 06/22/23 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 06/22/23 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, appeal rights discussed, and a copy of this report was provided to facility staff, Danette Mejico.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/22/2023 04:11 PM - It Cannot Be Edited

Created By: Giselle Carbullido On 06/22/2023 at 03:43 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: TRF ALL SAINTS	FACILITY NUMBER: 334846109
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/22/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/23/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision: (1) 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 is not met as evidenced by:	1 2 3 4 5 6 7	Director agrees to provide in-service training to staff regarding Responsibility for Providing Care and Supervision and has submitted proof of staff training to the Department during today's visit. AN IMMEDIATE CIVIL PENALTY HAS BEEN ASSESSED FOR $500.00.
	8 9 10 11 12 13 14	Based on LPA’s record review , staff and Parent interviews the facility did not maintain supervision of all children which resulted in a child being unsupervised int the paking lot. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	Director will submit statement of understanding of cited regulation above including monitoring of gate and communication with parents to the department by 06/23/23.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Gilbert Sena

LICENSING EVALUATOR NAME:

Giselle Carbullido

LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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