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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840409
Report Date: 05/08/2024
Date Signed: 05/08/2024 11:25:09 AM

Document Has Been Signed on 05/08/2024 11:25 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:OMSD/HAYNES ELEMENTARY SCHOOLFACILITY NUMBER:
364840409
ADMINISTRATOR/
DIRECTOR:		CRISTINA RASKOVICFACILITY TYPE:
850
ADDRESS:715 WEST FRANCIS STREETTELEPHONE:
(909) 984-1759
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Director, Gianna RocaTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR) from the facility.  The UIR was received by the licensing agency on 05/07/2024. Licensing Program Analyst (LPA) Blanca Ruiz met with licensee, Director, Gianna Roca. A prior inspection was made at the facility on 05/02/2024 to follow-up on the UIR submitted to the department within 24 hours. Facility was toured and census was taken. Parent(s)/Legal guardian of child(ren) involved in the incident are aware of all details.  Interviews were conducted and records were reviewed at the facility. Information obtained  indicates that on 04/29/2024,  Staff #1 who was substituting on site from the Ontario-Montclair School District( OMSD) made a spanking gestures to Child #1 and kissed the child on the cheek and attempted to put  Child#1 over Staff #1's legs. Staff #2 took the child  away from the situation. Staff#3 was informed of the incident and Staff#1 was immediately removed and escorted to the front of the office and sent  home. Human Resources was notified and Staff#1 will not be substituting at OMSD.

Child(re) involved in the incident was/were interviewed and expressed feeling safe and happy at school.

At the time of the incident there were 19 children present with 3 staff members. Staff #2 and#4 observed the incident and reported to Staff#3.  Based on the information gathered today, school staff  acted immediately to ensure the Health and Safety and Personal Rights of the children in care were respected according to the Title 22 Regulations.

No deficiencies are cited during inspection.

An exit interview conducted, and report was reviewed with Gianna Roca , Director. Appeal rights were discussed, and A Notice of Site Visit was given and must remain posted for 30 days.  Failure to comply with posting requirements shall result in an immediate civil penalty of $100. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC, UPON THEIR REQUEST, FOR THREE YEARS.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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