336300045-4-18-2023-10-CC-CMAZ-CRBP2M-20230428105609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336300045
Report Date: 04/18/2023
Date Signed: 04/18/2023 11:37:35 AM

Unsubstantiated

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 STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2023 and conducted by Evaluator Sumayya Habeebulla

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20230316145837

FACILITY NAME:	BOX SPRINGS ELEMENTARY PRESCHOOL		FACILITY NUMBER:	336300045
ADMINISTRATOR:	ADCOCK,JENNIFER		FACILITY TYPE:	850
ADDRESS:	11900 ATHENS DR.		TELEPHONE:	(951) 571-4716
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	24	CENSUS: 4	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Jennifer Adcock		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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- Due to lack of supervision, children engaged in inappropriate touching.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Sumayya Habeebulla arrived at the facility for the purpose of conducting a subsequent complaint visit, which includes concluding the investigation and delivering the investigation findings regarding the compliant investigation initiated on 03/16/23. LPA met with Preschool Principal Ms. Jennifer Adcock and discussed the above allegation.

On 04/05/23 LPA Habeebulla conducted interviews with the Preschool Principal and 2 staff members who are pertinent to this investigation, and along with interviews, the investigation revealed that:

See LIC 9099C for continuation

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20230316145837

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BOX SPRINGS ELEMENTARY PRESCHOOL	FACILITY NUMBER: 336300045
	VISIT DATE: 04/18/2023

NARRATIVE

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There is an allegation that due to lack of supervision, children engaged in inappropriate touching. Pertinent interviews revealed that C1 does not use the restroom often at the center and has little to no interaction with other children in the classroom. As per the classroom policy that the staff have implemented, children are only allowed to use the restroom one at a time. A staff member stands next to the restroom door to supervise children using the restroom. Staff have never witnessed more than one child entering the restroom or have never come across an incident where 2 children were in the restroom together. The restroom door is a half door that even when a child is inside an adult has visual observation of inside the restroom. Interviews also revealed that a maximum of 16 children are present in the classroom along with 3-4 staff members at any given time. Also, LPA was unable to obtain any medical documents stating that inappropriate touching had occurred to C1.

From the information received by interviews with pertinent parties the above allegation of lack of supervision cannot be verified. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Ms. Jennifer Adcock, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC9099 (FAS) - (06/04)

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