364846079-9-1-2023-09-CC-GSEA-CVSRCS-20230918125449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364846079
Report Date: 09/01/2023
Date Signed: 09/01/2023 11:07:00 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/07/2023 and conducted by Evaluator Justin Giese

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20230807082457

FACILITY NAME:	FORTUNE PRESCHOOL		FACILITY NUMBER:	364846079
ADMINISTRATOR:	MAYRA ESPINOZA		FACILITY TYPE:	850
ADDRESS:	655 W 2ND ST		TELEPHONE:	(909) 884-1410
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92410
CAPACITY:	36	CENSUS: 7	DATE:	09/01/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sahlah Abdulaziz-Storks		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Personal Rights - Staff inappropriately restrains day care children

INVESTIGATION FINDINGS:

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On 09/01/2023, at time listed above, Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of concluding a complaint investigation. The allegation of this complaint was received by Licensing on 08/07/2023. LPA was granted entry to the facility and met with Facility Interim Director, Sahlah Storks.

The following was alleged: Staff inappropriately restrains day care children

It was alleged that on 7/28/2023, two staff members were observed each restraining a child in the Facility’s hallway, outside of the preschool classroom. I was stated staff were seated on the ground and using their legs to hold/restrain the children down for an undisclosed period of time.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20230807082457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FORTUNE PRESCHOOL	FACILITY NUMBER: 364846079
	VISIT DATE: 09/01/2023

NARRATIVE

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As part of this investigation, LPA obtained and reviewed video footage corroborating the authenticity of this complaint allegation. LPA observed two staff members each holding a child between their legs. Staff were seated on the floor, backs to the wall, with their legs wrapped around the children’s waist/midsection area. Children were observed to be crying/screaming and attempting to escape the restraints of staff.

LPA conducted an unannounced visit to the facility to initiate this complaint investigation on 08/14/2023. At time of this visit LPA conducted interviews with pertinent parties and reviewed/collected documents. LPA made a subsequent visit to the facility on 08/24/2023 to conduct further interviews with staff. On 08/30/2023 LPA was contacted by a member of the Facility’s Management team. Facility Representative disclosed an internal investigation was conducted after they were made aware of a video and individuals involved corroborating the allegation of this complaint. LPA was informed Facility Director and the two Staff members involved in the video were terminated from the facility effective 08/30/2023.

Therefore, based on LPA’s observation of video evidence and Facility acknowledging the alleged incident occurred, the preponderance of evidence standard has been met, the above allegation, Staff inappropriately restrains day care children, are found to be SUBSTANTIATED. Please see attached LIC9099D for Type A deficiency cited.

An exit interview was conducted, A copy of this report and appeal rights were given to the Facility Interim Director during this inspection on 09/01/2023.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Facility Representative 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 childcare facility and any children enrolled into the childcare 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: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 09-CC-20230807082457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FORTUNE PRESCHOOL	FACILITY NUMBER: 364846079
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/02/2023 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	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... or other actions of a punitive nature... This was not met as evidenced by:	1 2 3 4 5 6 7	Facility Management acted quicky by terminating all staff involved in this incident. The facility will draft a statement of understanding to cease this practice immediately and outline an acknowledgement/training plan regarding children’s personal rights. This plan will be submitted to LPA
	8 9 10 11 12 13 14	Based on observations of video evidence and statements recorded, two facility staff members were observed holding/restrained children between their legs for an extended period of time. This ia an immediate health and safety and personal rights risk to children in care.	8 9 10 11 12 13 14	On or before the stated POC date of 09/02/2023. Once training has been conducted, Facility will submit staff acknowledgement/signatures of proof of training to LPA at a later date.
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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: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC9099 (FAS) - (06/04)

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