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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805816
Report Date: 02/18/2026
Date Signed: 02/18/2026 05:04:07 PM

Document Has Been Signed on 02/18/2026 05:04 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LIFE CHRISTIAN ACADEMYFACILITY NUMBER:
334805816
ADMINISTRATOR/
DIRECTOR:		KIMBERLY FREDERIQUEFACILITY TYPE:
850
ADDRESS:3270 RUBIDOUX BOULEVARDTELEPHONE:
(951) 684-3639
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 60TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
02/18/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Destiny Green, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On date and time listed above, Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct annual inspection. LPA was granted entry by Director Destiny Green. LPA toured the facility inside and out, reviewed records, took a census and observed and/or discussed the following.

Days and hours of operation are Monday - Friday; 6:00 AM-6:00 PM, Green, Yellow and Red Rooms. Blue Room is currently dormant due to low enrollment.

If updates are made, the facility representative will submit the following documents to Licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule
4. LIC 309 Administrative Organization and
5. LIC 308 Designation of Administrative Responsibility
6. LIC200A Application form updates.

The following items have been posted and are current: License; Emergency Disaster Plan (LIC610); Facility sketch; Earthquake Preparedness Checklist (LIC9148; Parent’s Rights Poster (PUB393); Personal Rights (LIC613A); Child Car Seat Law, and Menu. The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance, except as noted on the LIC809D. The facility is operating within the scope of license with appropriate ratios and supervision during this inspection. The LPA took a census of 5 children supervised by 4 staff.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LIFE CHRISTIAN ACADEMY
FACILITY NUMBER: 334805816
VISIT DATE: 02/18/2026
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No Medications are stored at the facility.
Hazardous and dangerous items are stored inaccessible to children.
Poisons and toxins are locked. Classrooms and floors are clean, free of hazards and rooms are equipped with age-appropriate furniture. Bathrooms were observed to be safe, sanitary and in operating condition
Per director no weapons are stored at the facility.
There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position. Outdoor activity areas are enclosed by appropriate fences, free of hazards and have age and size equipment in good condition. Areas around or under high climbing equipment have material that absorbs a fall: The LPA observed woodchips to cushion a fall. The facility has a shaded area.
Food preparation area is clean, free of litter, and vermin, and contamination.
Food is stored appropriately in the fridge. Menus are posted for public view, in advance. The agency provides a morning and afternoon snack. Children bring their own lunches. Menus are current, posted and visible for authorized representatives and available upon request.
Measures are taken to keep the facility free of pests and rodents.
Storage containers for solid waste have tight-fitting covers in good repair. Uncontaminated drinking water is readily available both indoors and outdoors: Dixie cups, water bottles, from water purchased by the facility.
Sign in/Sign out record was reviewed and meets regulation requirements on today’s date. A Staff member is present with CPR/First Aid which expires on 09/20/2027.
Opening and closing staff member’s CPR/First Aid expires on 06/17/2026
Director completed Health and Safety Training on 09/21/2025
Children files are complete on today’s date.
Staff have received on-the-job training for housekeeping, sanitation and universal health precautions Staff files are NOT complete: Staff present is missing proof of a LIC503 Health Screening.
Fire & earthquake drills are conducted/documented every six months. Last fire drill on 01/16/2026 at 9:58 AM, 2 staff and 3 students.
A fully charged fire extinguisher (2A:10BC) was observed and tagged by the fire department. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection on 02/18/2026.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LIFE CHRISTIAN ACADEMY
FACILITY NUMBER: 334805816
VISIT DATE: 02/18/2026
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Facility Representative was informed the Department has inspection authority per Health and Safety Codes. Facility representative was reminded of the following:
1. Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
2. Access to forms & Regulations online at www.ccld.ca.gov
3. Facility staff are responsible to know the regulations for providing care
4. Failure to meet the posting requirements shall result in an immediate civil penalty.
5. To receive important licensed -related information to licensed facilities, visit the CCLD Important

Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.

AB2960 – Childcare and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive childcare and development services online portal for families and providers by June 30, 2022.

Licensee director Destiny Green was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee Director Destiny Green was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LIFE CHRISTIAN ACADEMY
FACILITY NUMBER: 334805816
VISIT DATE: 02/18/2026
NARRATIVE
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The agency agrees to PROVIDE A WRITTEN ATTESTATION OF TESTING EXEMPTION: The licensee Director Destiny Green stated the agency uses alternative water sources for food preparation and consumption. The director stated the agency provides bottled water. The director stated the water bottles and jugs are purchased from the store and offered and children. The children area able to refill personal water bottles.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA referred Director Destiny Green to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.


on their purchased equipment.

A deficiency was issued on today’s date for a Type B violation.
No civil penalties were issued.
Exit interview conducted and report was reviewed with the Director Destiny Green.
A notice of site visit was given and must remain posted for 30 days. The LPA observed the licensee representative post the Notice of Site visit for public view.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/18/2026 05:04 PM - It Cannot Be Edited


Created By: Susan Brewer On 02/18/2026 at 04:49 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LIFE CHRISTIAN ACADEMY
FACILITY NUMBER: 334805816

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of a health screening for a subject staff present and caring for children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2026
Plan of Correction
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The licensee agrees to ensure all employees receive a good physical health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. The licensee also agrees to submit proof of a health screening for a subject staff by fax, mail or e-mail.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2026


LIC809 (FAS) - (06/04)
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