Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909315
Report Date: 09/08/2016
Date Signed: 09/08/2016 01:40:53 PM

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:V.I.P. TOTSFACILITY NUMBER:
330909315
ADMINISTRATOR:KAREN CALVILLOFACILITY TYPE:
850
ADDRESS:41861 E. ACACIA AVENUETELEPHONE:
(951) 652-7611
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:86CENSUS: 47DATE:
09/08/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Debie Haney, SIte Director TIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Sharleen Robinson and Stephen Randle arrived at the facility, for the purpose of conducting a case management follow-up visit; regarding an unusual incident report that was submitted by the facility on August 31, 2016. LPAs met with site Manager Debbie Haney, to discuss the reported incident. There were 47 children in care. LPAs toured the facility and reviewed records.

The reported incident is in regards to two children (child #1 and child #2) who may have had their personal rights violated. It was said that a staff member grabbed child #1 digging their fingernails into the child #1 arm and that the same staff member “smacked” another child’s hand. The Site Manager stated when the said incidents occurred there were 19 children in the classroom under the supervision of three staff members.

Those interviewed stated they were not aware of the said incidents. Those interviewed did not witness the said incidents and could not corroborate the allegation(s). Staff member #1 explained there was not a violation of children’s personal rights; instead Staff member #1 redirected child #1 and child #2 who were fighting by putting their hands in front of the children breaking up their fight and verbally redirected the children. The Site Manager was reminded per tittle 22 regulations section number 101223(a)(3) Personal Rights. Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. The Site Manager agrees to conduct and in-service meeting on September 9, 2016 to discuss personal rights.

The facility is providing IMS at this time, Site Manager was reminded to forward LPA Robinson the IMS plan. Based on the information obtained during the visit, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident, at this time.

An exit interview was held with Site manager Deborah Haney. A Notice of Site visit was issued, along with a copy of this report. No deficiency cited.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4950
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2016
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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