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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364801544
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:29:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/03/2024 and conducted by Evaluator Justin Giese
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20241203132549
FACILITY NAME:IMMANUEL BAPTIST PRE-SCHOOLFACILITY NUMBER:
364801544
ADMINISTRATOR:ALFORD, KIMBERLYFACILITY TYPE:
850
ADDRESS:28355 E. BASELINETELEPHONE:
(909) 862-6641
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:168CENSUS: 47DATE:
12/04/2024
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Kimberly AlfordTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Personal Rights - Staff injured daycare child
INVESTIGATION FINDINGS:
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On 12/04/2024 at time listed above, Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of initiating a complaint investigation. LPA met with Facility Director, Kimberly Alford regarding the above listed allegation, which was received on 12/03/2024.

The following was alleged: Staff injured daycare child

It was alleged on 11/26/2024, a child was inappropriately grabbed by staff causing injury. On 11/27/2024, the Facility self-reported and submitted an unusual incident report (UIR) to Licensing. The UIR documented an incident regarding a child injury. It was stated a child in care threw themselves to the floor resulting in an arm injury. An amended UIR was submitted from the facility on 12/02/2024 stating upon further review, it was determined a child in care sustained a possible arm fracture due to the handling of a staff member.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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 4
Control Number 09-CC-20241203132549
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: IMMANUEL BAPTIST PRE-SCHOOL
FACILITY NUMBER: 364801544
VISIT DATE: 12/04/2024
NARRATIVE
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On 12/03/2024, Licensing received a complaint pertaining to the above listed allegation. LPA Giese made an unannounced visit to the facility on 12/04/2024 to initiate this complaint investigation. At time of visit, LPA met with Facility Director, discussed the purpose of visit, and pending allegation. It was determined the UIR submitted on 11/26/2024 corroborated persons of interest and alleged events surrounding this complaint.

LPA was informed by Director the Facility had conducted its own investigation pertaining to the submission of the UIR. Director stated the Facility reviewed surveillance video which corroborated the alleged incident had occurred. At time of this visit, LPA reviewed and observed the surveillance video multiple times and discussed its events with Facility Management.

The surveillance video shows a child in care begin to remove their short sleeve tee-shirt. The child’s back is shown to the available camera angle. The child pulls their shirt up over their head with their arms pointed upwards. A staff member intervenes by walking to the child, dropping down to their knees at the child’s level and begins to assist the child by pulling their shirt back down over their head. Staff is observed assisting the child place their arms back into their sleeves. After successfully getting the child’s shirt back on their body, staff is observed grabbing the child’s arms and lowering them down to the child’s sides, Staff maintains hold of the child’s wrists and begins speaking to them, face to face. The child begins to move and break free from the Staff’s grasp, the child attempts to pull away and abruptly drops themselves to the floor. Staff maintains their grasp of the child’s wrists and abruptly pulls the child upwards back to their feet, lifting the Child’s arms to a fully extended/locked position above their head. The child is observed to be crying and attempting to evade the Staff member. The staff releases their grasp of the child and then reaches out and grabs the child by the arms above the elbows, Staff straightens the child’s posture, turns the child to face them and begins talking to the child again, whilst holding on to their arms. Staff repositions their hands and places them low on the child’s hips, the child is observed to be crying, grasping their right forearm with their left hand.

It was reported the child sustained a fracture in their right forearm from the noted incident. In addition to reviewing the surveillance footage, LPA obtained pertinent documents which corroborate the child’s injury and medical diagnosis.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 09-CC-20241203132549
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: IMMANUEL BAPTIST PRE-SCHOOL
FACILITY NUMBER: 364801544
VISIT DATE: 12/04/2024
NARRATIVE
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Based on LPAs observations, interviews conducted, and records reviewed/obtained, the preponderance of evidence standard has been met, therefore the above allegation, Staff injured daycare child, are found to be SUBSTANTIATED. Please see attached LIC9099D for Type A deficiency cited.

A Civil Penalty of $500 will be assessed during this investigation for a violation of Personal Rights. 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.

An exit interview was conducted, A copy of this report and appeal rights were given to the Director during this inspection on 12/04/2024.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Director understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Licensees are required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file.

A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 09-CC-20241203132549
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: IMMANUEL BAPTIST PRE-SCHOOL
FACILITY NUMBER: 364801544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2024
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain...

This was not met as evidenced by:
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IMMEDIATE CIVIL PENALTY OF $500 WILL BE ASSESSED
Facility Director understands the importance of children's personal rights while in care. Facility director agrees to conduct staff training regarding topics of personal rights and physical handling of children.
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Based on observation and interview Facility self reported this incident and provided surveillance video for review which showed a staff member grab a child by the wrists and lift them up, resulting in a forearm fracture. This ia an immediate health, safety and personal rights risk to children in care.
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Documentation of training/staff Acknowledgement is due by POC date of 12/05/2024.

Submission can be made via email:
justin.giese@dss.ca.gov
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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: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4