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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701164
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:40:00 PM

Document Has Been Signed on 01/04/2024 02:40 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:TOGETHER WE GROW-INFANTFACILITY NUMBER:
376701164
ADMINISTRATOR:KIMBERLY CIERZANFACILITY TYPE:
830
ADDRESS:2120 THIBODO ROADTELEPHONE:
(760) 757-6031
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 17DATE:
01/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Karina MoedanoTIME COMPLETED:
02:50 PM
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On January 4, 2024 at 12:15 pm, Licensing Program Analyst (LPA) William Chancellor arrived unannounced to Together We Grow (CCC) to conduct a case management visit. The purposed of the visit is regarding an Unusual Incident Report (UIR) received for an incident that occurred on 12/15/23. The incident in question involved staff observing a child (C1) receiving inappropriate discipline from another staff. LPA met with Facility Representative Karina Moedano and conducted a tour of the facility.

During the visit, LPA conducted interviews with five staff (S1-S5) all of whom were present during and or involved after the incident. Interviews revealed the staff were in ratio at the time of the incident and S5 notified management, resulting in appropriate employee disciplinary measures being taken. The child did not require any medical attention or receive any injuries. Parents of C1 were immediately notified and CCC self reported the incident to CCL with a UIR.

LPA determined that the facility was not in violation of Title 22 Regulations at this time.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Facility Representative Karina Moedano .

A notice of site visit was also provided and must remain posted for 30 consecutive days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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