364808410-5-4-2023-09-CC-JGIE-CRHPJL-20230504112142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808410
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:21:51 AM

Document Has Been Signed on 05/04/2023 11:21 AM - 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:	SAN BERNARDINO CITY SCHOOL DIST. ALLRED		FACILITY NUMBER:	364808410
ADMINISTRATOR:	KELLY, LATASHIA		FACILITY TYPE:	830
ADDRESS:	303 S. K STREET		TELEPHONE:	(909) 386-2508
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92410
CAPACITY: 38	TOTAL ENROLLED CHILDREN: 38	CENSUS: 14	DATE:	05/04/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Deobrah Johnson		TIME COMPLETED:	11:30 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 05/04/2023 Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility to conduct a case management visit. LPA met with Facility Site Supervisor, Deborah Johnson, and discussed the purpose of visit.

On 04/17/2023, LPA made an unannounced visit to the facility for a separate investigation. During the investigation, LPA obtained information pertaining to the infant/toddler program operating out of staff/child ratio.

LPA conducted interviews with staff associated with the infant/toddler program and recorded the following information:

It was disclosed the infant/toddler program often operates out of the required staff/child ratios. The total number of staff to children in attendance are reflected daily on internal “Child Ratio Schedule” forms. Staff stated they are aware of the required staff to child ratios, however; the facility does not have enough staff to meet proper ratios in the mornings and late afternoon hours.

LPA reviewed a total sample of 10 Child Ratio Schedules from 04/03/2023 to 04/14/2023 and noted the following:

LPA noted one occurrences where the facility was out of ratio between 07:00am to 08:00am and four occurrences between 04:00pm to 05:00pm. All noted occurrences would have required the facility to have one additional staff member present to meet required ratios.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: SAN BERNARDINO CITY SCHOOL DIST. ALLRED	FACILITY NUMBER: 364808410
	VISIT DATE: 05/04/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

· 04/03/2023 (04:00pm – 05:00pm) 2 staff, 9 children
· 04/04/2023 (04:00pm – 05:00pm) 2 staff, 10 children
· 04/05/2023 (04:00pm – 05:00pm) 2 staff, 9 children
· 04/06/2023 (04:00pm – 05:00pm) 2 staff, 10 children
· 04/07/2023 (07:00am – 08:00am) 2 staff, 12 children

Therefore, based on interviews conducted and records reviewed, the Facility was found to be in violation of the following Title 22 Regulation:

101416.5 Staff-Infant Ratio

(b) There shall be a ratio of one teacher for every four infants in attendance

This poses a potential health/safety, or personal rights risk to persons in care. SEE LIC809D for Type B Deficiency

An exit interview was conducted, A copy of this report and appeal rights were given to the Facility Site Supervisor during this inspection on 05/xx/2023.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 05/04/2023 11:21 AM - It Cannot Be Edited

Created By: Justin Giese On 05/04/2023 at 08:46 AM

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: SAN BERNARDINO CITY SCHOOL DIST. ALLRED	FACILITY NUMBER: 364808410
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/18/2023 Section Cited CCR 101416.5(b)	1 2 3 4 5 6 7	101416.5 Staff-Infant Ratio (b) There shall be a ratio of one teacher for every four infants in attendance. This was not met as evidenced by:	1 2 3 4 5 6 7	Facility is aware of the importance of this regulation and as a means of correction will hold a staff meeting and training session outlining how to properly maintain proper documentation of staff/child ratios, in addition topics will discuss staff expectations while working in the infant program.
	8 9 10 11 12 13 14	Based on LPA observation, interviews and records reviewed, ten "Child Ratio Schedules" for the month of April 2023 were reviewed. On 1 occurrences the facility was out of ratio between 7:00am to 8:00am and 4 occurrences between 4:00pm to 5:00pm. This poses a potential health/safety, or personal rights risk to persons in care	8 9 10 11 12 13 14	Facility will submit training materials and staff sign-in sheet for attendance and acknowledgement to the LPA on or before the stated POC date of 05/18/2023. justin.giese@dss.ca.gov
	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:

Gilbert Sena

LICENSING EVALUATOR NAME:

Justin Giese

LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3