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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 04/26/2024
Date Signed: 04/26/2024 02:22:47 PM

Document Has Been Signed on 04/26/2024 02:22 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:PSD/ONTARIO HEAD STARTFACILITY NUMBER:
364801214
ADMINISTRATOR/
DIRECTOR:		WILLIAM ALVAREZFACILITY TYPE:
850
ADDRESS:555 W. MAPLE AVENUETELEPHONE:
(909) 984-4117
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 224TOTAL ENROLLED CHILDREN: 224CENSUS: 26DATE:
04/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Current /Site Supervisor(s) Meenakshi Verma and Monica PargaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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An unannounced case management inspection was conducted by License Program Analysts (LPAs) Blanca Ruiz and Rachel Zeron. LPA met with  Site Supervisor, Verma Meenakshi and Site Supervisor II, Monica Parga and stated the purpose of today's inspection.  The center was toured, and a census were taken. 
The purpose of the inspection was to follow up on an incident learned during an investigation of complaint 09-CC-20240426080553.  Parent(s) of the child(ren) involved are aware of the incident(s).

During inspections conducted on 04/04/24 and 04/26/24 it was learned that Child#1 ran out of the preschool playground through the side gate next to the facility entrance.  Per information provided during interviews, staff immediately follow the child as child pushed the bar gate and walked out of the facility playground which leads to a small school parking lot. Child's mother arrived at the parking lot while the child was running and staff were behind the child. Child's mother confirmed child being safe and not scare of the incident.

The following deficiencies were cited:

101212(d)(1)(C) Reporting Requirements.  Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence. The center failed to report the incident of Child#1 to community care licensing (CCL) on a timely manner.
Licensee failed to report an unusual incident that occurred at the facility that jeopardized the health and safety of the child(ren) in care.

Licensee was reminded to be in close communication with Community Care Licensing (CCL) to address any questions, concerns and/or to verify substantial compliance. Lastly, licensee was advised to contact the Duty Officer available Monday-Friday 8:00 a.m. to 5:00 p.m. to obtain clarification if needed at (951)782-4200.

Please see Lic 809C and Lic 809D
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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: PSD/ONTARIO HEAD START
FACILITY NUMBER: 364801214
VISIT DATE: 04/26/2024
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101226.3(b) Observation of the Child. Any unusual behavior, any injury or signs of illness requiring assessment and/or administration of first aid by staff shall be reported to the child's authorized representative and recorded in the child's record. Per files reviews conducted during inspection 04/04/24 and 04/26/24 no ouch/incident(s)reports related behavior nor injuries were documented for Child#1.

Please See LIC809-D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted and a copy of this report was given to Site Supervisor, Meenakshi Verma and Site Supervisor II, Monica Parga. Notice of Site Visit was given and must remain posted on, or immediately adjacent to, the interior of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/26/2024 02:22 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 04/26/2024 at 12:01 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: PSD/ONTARIO HEAD START
FACILITY NUMBER: 364801214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
CCR
101212(d)(1)(C)

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Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence. This requirement was not met as evidenced by:
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Facility agrees to provided a memo of understanding for all staff ( signatures required)regarding responsabilities of Reporting Requirements/Unusual Incidents by deadline.
Facility submitted Lic 624 report after inspection conducted on 04/04/24.
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The center failed to report the incident of Child#1 running out of the facility on 03/21/24 to community care licensing (CCL) on a timely manner.
This is an potential Health and Safety Risk for the children in care.
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Type B
05/03/2024
Section Cited
CCR101226.3(b)

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101226.3(b) Observation of the Child. Any unusual behavior, any injury or signs of illness requiring assessment and/or administration of first aid by staff shall be reported to the child's authorized representative and recorded in the child's record. This requirement was not met as evidenced by:
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Licensee/facility agrees to provided "ouch/incident reports" to all parents detailing incidents involving their children. Licensee will submit a sign ( Facility Director/ legal guardian) document to CCL informing parent/legal guardian of all incidents involving Child#1.
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Per files review conducted by LPAs during inspection 04/04/24 and 04/26/24 no ouch/incident(s) reports related behavior nor injuries were documented for Child#1.

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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.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024


LIC809 (FAS) - (06/04)
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