360911439-4-25-2023-09-CC-SLOZ-CR8SWU-20230425141454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360911439
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:14:59 PM

Document Has Been Signed on 04/25/2023 02:14 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:	FUSD/TOKAY ELEMENTARY		FACILITY NUMBER:	360911439
ADMINISTRATOR:	DARCY WHITNEY		FACILITY TYPE:	850
ADDRESS:	7846 TOKAY AVENUE		TELEPHONE:	(909) 357-5770
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 15	DATE:	04/25/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Assistant Director Maria Garces		TIME COMPLETED:	02:40 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Samuel Lopez, Taityana Benson, and Raymond Moorehead arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 3/17/2023. The UIR documented an incident involving a staff that allegedly pushed a child.

Upon arrival this date on 4/25/2023, LPAs Lopez, Benson, and Moorehead met with facility Assistant Director Maria Graces and stated the purpose of the visit. Previously, on 4/6/2023, records were reviewed and interviews were conducted. Since that date and up until now, additional information was obtained regarding the incident. In reviewing all the information from documents and/or interviews, the following was determined: During play time, a child began to exhibit frustration and other behavioral issues. Staff attempted to curve the behavior by talking to the child as the child moved around throwing items around. As more than one staff attempted to address the child's behavior, the child appeared more frustrated which caused the child to continue by knocking down chairs and throw paper on to the floor. The child was then trying to grab a cup with crayons to throw and that is when two additional staff witnessed the child being pushed to the ground by another staff. The staff member who allegedly pushed the child denied the allegation and claimed that the child threw themselves on the ground without any contact. However, information obtained from statements provided on the day of the incident, the staff member disclosed trying to "retain" the child. Also, the information/statements obtained from witnesses were verified by the same witnesses.

Based on the information gathered, the preponderance of evidence standard has been met facility, that staff failed to comply with the regulation pertaining to Personal Rights and facility policy regarding handling children and their behavior.

See LIC809-D for cited deficiency.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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: FUSD/TOKAY ELEMENTARY	FACILITY NUMBER: 360911439
	VISIT DATE: 04/25/2023

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LPA Samuel Lopez informed Assistant Director Maria Garces that this report dated April 25, 2023 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.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Also, LPA Samuel Lopez informed the Assistant Director Maria Garces to provide a copy of this licensing report dated April 25, 2023 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.

Exit interview conducted and report was reviewed with the Assistant Director Maria Garces.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/25/2023 02:14 PM - It Cannot Be Edited

Created By: Samuel Lopez On 04/25/2023 at 01:31 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: FUSD/TOKAY ELEMENTARY	FACILITY NUMBER: 360911439
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/26/2023 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Staff in question was not present at the time of the visit. Licensee representative agrees to have a meeting regarding the cited regulation. Licensee representative agrees to provide an agenda and sign in sheet from the meeting to the Riverside Child Care Regional Office by 4/26/2023.
	8 9 10 11 12 13 14	Based on interviews and record review, a staff did not comply with the section cited above. A staff was witnessed pushing a child down to the floor, in the classroom. This poses/posed an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	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:

Aaron Ross

LICENSING EVALUATOR NAME:

Samuel Lopez

LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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