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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846374
Report Date: 12/19/2024
Date Signed: 12/19/2024 09:56:44 AM

Document Has Been Signed on 12/19/2024 09:56 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EASTER SEALS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364846374
ADMINISTRATOR/
DIRECTOR:		ESTELA PEREZFACILITY TYPE:
830
ADDRESS:1102 WEST PHILLIPS STREETTELEPHONE:
(909) 981-4668
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 16DATE:
12/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Elizabeth Mulligan, Area DirectorTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 12/19/2024 at 8:30 AM, a case management visit 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 12/17/2024. It indicates that a infant was left unsupervised in a classroom.

Facility records (UIR self report) was reviewed, and interviews were conducted with pertinent parties, including staff. Staff interviews stated an infant was left inside the classroom when the staff and other children transitioned to the Nap Room.

Based on the information gathered, the following violations have been identified:


Responsibility for Providing Care and Supervision CCR 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
See LIC809D for cited deficiency.

LPAs Chase Atherton and Giselle Carbullido informed Area Director, Elizabeth Mulligan that this report dated 12/19/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Chase Atherton and Giselle Carbullido informed the Area Director, Elizabeth Mulligan to provide a copy of this licensing report dated 12/19/2024 that documents any Type A citation(s) to parents of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, appeal rights discussed, and a copy of this report and notice of site visit were provided to Area Director, Elizabeth Mulligan.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Chase Atherton
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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Document Has Been Signed on 12/19/2024 09:56 AM - It Cannot Be Edited


Created By: Chase Atherton On 12/19/2024 at 08:42 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
FACILITY NUMBER: 364846374

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in.... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Area Director agrees to provide in-service training to staff regarding Responsibility for Providing Care and Supervision and will submit proof of training, including staff attendance sheet, to the Department by the close of business day December 20, 2024.
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Based on LPA interviews conducted and facility self report, the facility did not maintain supervision of all children which resulted in a child being left unsupervised in the classroom. This is an immediate health and safety risk to the children in care.
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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:Ana Noble
LICENSING EVALUATOR NAME:Chase Atherton
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


LIC809 (FAS) - (06/04)
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