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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300358
Report Date: 12/19/2024
Date Signed: 12/19/2024 10:34:15 AM

Document Has Been Signed on 12/19/2024 10:34 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:COLES COTTAGE ACADEMYFACILITY NUMBER:
376300358
ADMINISTRATOR/
DIRECTOR:		COSTA,WEERATUNGAFACILITY TYPE:
850
ADDRESS:505 CIVIC CENTER DRTELEPHONE:
(949) 836-4465
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 35TOTAL ENROLLED CHILDREN: 28CENSUS: 18DATE:
12/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:29 AM
MET WITH:Facility Representative Brenda Mesa TIME VISIT/
INSPECTION COMPLETED:
10:54 AM
NARRATIVE
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 On the above date and time, Licensing Program Analyst (LPA) Kelly Gerth arrived at Coles Cottage Academy (CCC) to conduct a case management visit regarding an Unusual Incident Report (UIR) received by CCLD on 11/05/2024 for an incident that occurred at the CCC on 10/28/2024. LPA met with Facility Representative/Teacher Maricela Adame, who stated that the Director was not yet in. LPA explained the reason for the visit and was provided a tour of the classrooms to conduct census. After census was taken, Facility Representative, Office Manager Brenda Mesa arrived, met with LPA, stating the Director was in transit to the CCC. LPA again explained the reason for the visit. The UIR stated that Adult 1 A1) arrived to pick up Child 1 (C1) during rest time and witnessed Staff 1 (S1) pushing C1 onto a nap mat and yelling at C1, insisting C1 remain on the mat during rest period. The CCC stated they met with S1 who stated that S1 did not push nor yell instead placed hands to guide the child onto the mat and firmly spoke to C1. At this time the CCC then issued a verbal warning to S1 and at the following staff meeting, conducted a personal rights training for all staff members.
Based on interviews with staff and S1’s written statement it is confirmed that S1 did place their hands onto C1, insisting that the child remain on the nap mat during rest, which is a violation of personal rights. The facility is being cited for violation of Title 22, See D page.
An exit interview was conducted and a copy of this report along with appeal rights were provided to Facility Representative Brenda Mesa, A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
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 10:34 AM - It Cannot Be Edited


Created By: Kelly Gerth On 12/19/2024 at 10:16 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2025
Section Cited
CCR
101223(a)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights (3) To be free from.. [....] This requirement is not met as evidenced by:
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Licensee agrees to conduct an updated personal rights training for all staff submit a copy of the training materials and staff sign in/out to CCLD by COB 01/17/2025.
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Based on evidence gathered and interviews, it was revealed that a staff member (S1) at the CCC did violate a child’s (C1) personal rights when attemtping to force a child to stay on the nap mat during rest time.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
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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