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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336300393
Report Date: 03/08/2024
Date Signed: 03/08/2024 10:21:00 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 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
02/23/2024 and conducted by Evaluator Amber Shaw
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240223134425
FACILITY NAME:SUNNYMEADOWS ELEMENTARY PRESCHOOLFACILITY NUMBER:
336300393
ADMINISTRATOR:ADCOCK, JENNIFERFACILITY TYPE:
850
ADDRESS:23200 EUCALYPTUS AVETELEPHONE:
(951) 571-4716
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:30CENSUS: 16DATE:
03/08/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Star MonvilleTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not prevent child in care from harming other children
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA), Amber Shaw and Anastasia Flores, made a subsequent unannounced complaint investigation visit to deliver the findings for the above referenced allegations. LPA met with Star Monville, (Director), who was informed of the decision rendered.

On February 23,2024, Community Care Licensing (CCL) received a complaint alleging that Staff did not prevent child in care from harming other children. During course of investigation, LPA conducted interviews with pertinent parties and records were reviewed. Per interviews and information gathered, it was revealed that C1 had behavioral issues, specifically with hitting other children, and staff did not take action to prevent C1 from harming other children. Interviews also revealed that there had been several incidents where C1 was physical with children and staff. SEE LIC 9099-C FOR CONTINUATION.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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 10-CC-20240223134425
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
101223(a)(2)
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101223(a)(2) Personal Rights The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations... to meet his/her needs
This requirement was not met as evidenced by:
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Director will provide plan of correction in regards to personal rights for all staff and provide to LPA Shaw via email by 3/15/24
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Based on Interviews and record review, S5 allowed C1 to harm other children in care. This poses a potential health safety personal rights risk to persons 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: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 10-CC-20240223134425
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: SUNNYMEADOWS ELEMENTARY PRESCHOOL
FACILITY NUMBER: 336300393
VISIT DATE: 03/08/2024
NARRATIVE
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LPA verified that C1 required a teacher to shadow them, however, staff were not actively doing so resulting in child harming children and staff. Based on the information obtained, the preponderance of evidence standard has been met and the allegation staff did not prevent child in care from harming other children is SUBSTANTIATED. The facility is cited under Title 22, Section 101223 (a) (2) Personal Rights. See deficiency report (9099-D) for citation cited.

An exit interview was conducted, and a copy of this report, LIC 9099-D, and appeal rights was provided to Star Monville, Director. A notice of Site Visit was issued and must be posted for 30 days. This report must be made available at the facility for 3 years for public review upon request.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3