PSD/DEL ROSA HEAD START

Type B citation from complaint investigation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32C1 began kicking S3, S3 then reached down and grabbed C1 by the upper right arm firmly and C1 cried. Additional staff members were present in the classroom during this incident and although they did not observe the incident, they heard C1 complain about S3 actions. Inconsistent information was received regarding if C1 received a mark or bruise because of this incident. Interviewees revealed this was an isolated incident and S3 was described as having positive interactions with the children in care. As a result of this incident S3s employment with the facility was terminated. Based on the interviews conducted and a review of the records, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. A citation was issued on the LIC 9099D for California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101223 (a) (3). A Notice of Site Visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with facility representative Melissa Ragagukguk. SUPERVISORS NAME: Lady King LICENSING EVALUATOR NAME: Kendal Zirbes LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024 FACILITY NAME: PSD/DEL ROSA HEAD STARTFACILITY NUMBER: 360911141 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 03/20/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/25/2024 Section Cited CCR 101223(a)(3)1 2 3 4 5 6 7Personal Rights 101223 (a) The licensee shall ensure that each child is… (3)…To be free from corporal or unusual punishment, infliction of pain, humiliation... This requirement was not met as evidenced by: 1 2 3 4 5 6 7Per facility representative , S3 employment with the center was terminated january 23, 2024. In formal staff training regarding personal rights occured on 1.28.24 and 1.22.24. A Personal Rights training will occur with the staff on 3.21.24, a copy the Agenda and sign in sheet will be submitted. 8 9 10 11 12 13 14Based on interviews and record review, the Licensee did not ensure C1 was free from infliction of pain, when S3 grabbed C1 firmly on the upper right arm on January 18, 2024, which poses a potential Health, Safety or Personal Rights risk to the persons in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISORS NAME: Lady King LICENSING EVALUATOR NAME: Kendal Zirbes LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32C1 began kicking S3, S3 then reached down and grabbed C1 by the upper right arm firmly and C1 cried. Additional staff members were present in the classroom during this incident and although they did not observe the incident, they heard C1 complain about S3 actions. Inconsistent information was received regarding if C1 received a mark or bruise because of this incident. Interviewees revealed this was an isolated incident and S3 was described as having positive interactions with the children in care. As a result of this incident S3s employment with the facility was terminated. Based on the interviews conducted and a review of the records, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. A citation was issued on the LIC 9099D for California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101223 (a) (3). A Notice of Site Visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with facility representative Melissa Ragagukguk. SUPERVISORS NAME: Lady King LICENSING EVALUATOR NAME: Kendal Zirbes LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024 FACILITY NAME: PSD/DEL ROSA HEAD STARTFACILITY NUMBER: 360911141 DEFICIENCY INFORMATION FOR THIS PAGE:VISIT DATE: 03/20/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 03/25/2024 Section Cited CCR 101223(a)(3)1 2 3 4 5 6 7Personal Rights 101223 (a) The licensee shall ensure that each child is… (3)…To be free from corporal or unusual punishment, infliction of pain, humiliation... This requirement was not met as evidenced by: 1 2 3 4 5 6 7Per facility representative , S3 employment with the center was terminated january 23, 2024. In formal staff training regarding personal rights occured on 1.28.24 and 1.22.24. A Personal Rights training will occur with the staff on 3.21.24, a copy the Agenda and sign in sheet will be submitted. 8 9 10 11 12 13 14Based on interviews and record review, the Licensee did not ensure C1 was free from infliction of pain, when S3 grabbed C1 firmly on the upper right arm on January 18, 2024, which poses a potential Health, Safety or Personal Rights risk to the persons in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISORS NAME: Lady King LICENSING EVALUATOR NAME: Kendal Zirbes LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024

Type B citation - potential risk if not corrected