Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909315
Report Date: 09/07/2017
Date Signed: 09/07/2017 02:15:18 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:MARCELLA ARNOLDFACILITY TYPE:
850
ADDRESS:41861 E. ACACIA AVENUETELEPHONE:
(951) 652-7611
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:86CENSUS: 34DATE:
09/07/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Debbie Haney, Site ManagerTIME COMPLETED:
02:25 PM
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Licensing Program Analysts (LPAs) Sharleen Robinson and Gilbert Sena 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, 2017. LPAs met with site Manager Debbie Haney, to discuss the reported incident. There were 34 children in care. LPAs toured the facility and reviewed records. The reported incident is in regards to a possible lack of supervision resulting in a personal rights violation.

It was said that a child may have fallen at the facility resulting in the child sustaining a concussion. The date that the said incident occurred the facility was within ratio 4 children to one teacher, none of the staff or other children interviewed witnessed the child falling. Per the Director On August 29, 2017 at approximately 12:00 PM a Teacher reported to the Director that child #1 was complaining of pain in their right ear. Staff provided first aide to the child, the child did not have a fever, the child’s parent was called a message was left. The parent was called a second time; the Director spoke with the parent and advised the parent that the child needed to be seen by a Dr. the child was taken to the Dr. where the child was diagnosed with a concussion. The child’s parent was unsure how the child sustained the injury, and was under the impression that the child fell off playground equipment “toy train” LPA Sena toured the playground(s) and did not observe a toy train. LPAs learned that on August 29, 2017, the children did not play outside due to excessive heat conditions. Those interviewed stated they did not see the child fall or complain of head pain and they were not aware of the said incident. Staff member #1 explained there was not a violation of children’s personal rights or lack of supervision, instead the staff believe the child may have sustained injury while visiting a relative overnight on August 28, 2017.

Based on the information obtained during the visit, LPAs could not determine if there was a violations of Title 22 Regulations pertaining to the reported incident, at this time. 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 to discuss personal rights safety concerns September 29, 2017. 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: Aaron RossTELEPHONE: (951) 784-4200
LICENSING EVALUATOR NAME: Sharleen RobinsonTELEPHONE: (951) 782-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2017
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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