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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817394
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:32:27 PM

Document Has Been Signed on 06/17/2021 12:32 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:EASTER SEALS CHILD DEVELOPMENT CENTER-ONTARIOFACILITY NUMBER:
364817394
ADMINISTRATOR:APRYL CABRERAFACILITY TYPE:
830
ADDRESS:2999 S. HAVEN AVETELEPHONE:
(909) 923-3352
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kassandra Torres - Director TIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Rachel Zeron and Carlos Martinez, arrived to follow up on an unusual incident report that was submitted to Licensing by the facility on 06/14/21. LPA met with Director Kassandra Torres to discuss the incident. LPAs toured the facility.

According to Torres, Child #1 went missing after teacher #1 and teacher #2 came in from the playground. Torres stated that staff conducted a head-count, and teacher #1 noticed that Child #1 was missing and immediately ran back out to the playground. where Child #1 was sitting on the infant soft play area, with arms up and smiling at teacher #1. Child #1 was found safe and taken back to the classroom.

See LIC 809D for deficiencies cited. This is a ZERO-TOLERANCE violation that presented and immediate risk to the child's safety. An exit interview was conducted, appeal rights discussed and a copy of this report was provided.

THE NOTICE OF SITE VISIT IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF THE TYPE A DEFICIENCY (LIC809D) CITED DURING THIS INSPECTION. A COPY OF THE TYPE A DEFICIENCY CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
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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Document Has Been Signed on 06/17/2021 12:32 PM - It Cannot Be Edited


Created By: Rachel Zeron On 06/17/2021 at 11:06 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: EASTER SEALS CHILD DEVELOPMENT CENTER-ONTARIO
FACILITY NUMBER: 364817394

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2021
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION:

No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time. This requirement was not met as evidenced by LPA Zeron and Martinez, who
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Director conducted training for "Name to face policies and procedures" and provided a copy to LPAs on this date. LPAs will review training.
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confirmed that Child #1 went missing on 06/14/2021, and was found in the playground after 10 - 15 seconds, Teacher #1 retrieved child #1, who was found safe in the soft play area
This is a Zero-Tolerance violation that presented and immediate risk to the child's safety.
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2021


LIC809 (FAS) - (06/04)
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