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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334812640
Report Date: 05/17/2021
Date Signed: 05/17/2021 11:02:35 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2021 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210427101713
FACILITY NAME:MAGNOLIA PRESCHOOL AND KINDERGARTENFACILITY NUMBER:
334812640
ADMINISTRATOR:ARLIDA ESPINOZAFACILITY TYPE:
850
ADDRESS:13130 MAGNOLIA AVENUETELEPHONE:
(951) 272-0977
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:104CENSUS: 24DATE:
05/17/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Arilda Espinoza, DirectorTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Facility is dirty.
INVESTIGATION FINDINGS:
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On 05/17/2021 at 8:30am Licensing Program Analyst (LPA) Giselle Carbullido conducted an unannounced tele-investigation regarding a complaint received concerning the above allegations. Due to the executive order issued by Governor Newsom on March 16, 2020 regarding COVID-19 pandemic, this investigation was conducted via tele-inspection (Facetime). LPA was given access to the facility by Arilda Espinoza, Director. LPA discussed purpose of tele visit, took census and toured the facility. LPA met with the Director to further discuss the complaint allegations and deliver findings. A previous complaint inspection was conducted on 05/04/2021 regarding the complaint, on that visit, staff interviews were conducted and records and photos were obtained.
It was alleged the facility is dirty. During today’s investigation, LPA toured the facility and reviewed records and photos.
During the course of the investigation, LPA toured facility and made the following observations 05/04/21:
At 11:41am unflushed toilet and toilet paper on floor. At 11:47am observed sink with dirt and rust including built up dirt around perimeter of sink and counter area. At 11:48am observed area rug with stains.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 09-CC-20210427101713
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAGNOLIA PRESCHOOL AND KINDERGARTEN
FACILITY NUMBER: 334812640
VISIT DATE: 05/17/2021
NARRATIVE
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At 11:49am observed dirty floor and cluttered side yard with toys. LPA also observed toy kitchen play structure with dirt prints on it and at 11:46am a second sink area with dirt and dirty portable fan on counter.

Additionally, LPA observed the following items in need of cleaning and repair: 11:46am wall with peeling/chipped paint; 11:49am cubbies with chipped paint and old residue from stickers/decorations; 11:50am torn screen, 12:03 tarnished and rusted serving cart; 12:36pm building portable with rotting/missing wood on the base and 12:38pm wrought iron fence with two broken bars.

Record review revealed cleaning check off lists signed off by staff and a text maintenance request and invoice for fence repair. Director and staff interviews reported regular cleaning routines and removal of trash at end of shifts and at closing.

This agency has investigated the complaint regarding facility being dirty. Based on the information obtained from interviews, pictures and LPA’s own observation, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 CCR 101238(a) are being cited on the attached LIC 9099D.

See LIC 9099D for deficiencies cited.

An exit interview was conducted, and appeal rights discussed. LPA Carbullido provided Director, Ms Espinoza with a copy of this report, appeal rights and Notice of Site visit via email with an electronic “read receipt”. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report was emailed to Licensee during this Tele-inspection on May 17, 2021.

A copy of this report must be made available to the public upon request for three years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 09-CC-20210427101713
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MAGNOLIA PRESCHOOL AND KINDERGARTEN
FACILITY NUMBER: 334812640
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2021
Section Cited
CCR
101238(a)
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 101238(a) Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
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Director will submit work order for cleaning and maintenance by POC due date 05/21/21. Director will send in proof of completion (pictures, paid invoices) to LPA Carbullido by POC due date 06/04//21.
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Based on LPA observations, review of records and photos: Facility did not maintain clean, safe and sanitary conditions (dirty sinks, carpet, fans, cubbies, and walls etc.) This poses a potential risk to the Health and Safety to children in care.
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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.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC9099 (FAS) - (06/04)
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