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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812640
Report Date: 01/28/2025
Date Signed: 01/28/2025 05:03:54 PM

Document Has Been Signed on 01/28/2025 05:03 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:MAGNOLIA PRESCHOOL & KINDERGARTENFACILITY NUMBER:
334812640
ADMINISTRATOR/
DIRECTOR:		RUTH GUTIERREZFACILITY TYPE:
850
ADDRESS:13130 MAGNOLIA AVENUETELEPHONE:
(951) 272-0977
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 104TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
01/28/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Assistant Directors Arilda Espinoza and Fanny Torres.TIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On 01/28/2025 at 8:10 AM Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by a staff Shannon Arrellano and granted entry to tour the facility inside and out. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Per S. Arrellano, the director Erica Murrieta and Assistant Director Arilda Espinoza, were away from the facility. At 8:34 AM a lead Teacher Fanny Torres, arrived to at the facility and joined the inspection. At 9:00 AM the Assistant Director Arilda Espinoza joined the inspection.

Normal days and hours of operation: Monday- Friday, 6:00 AM to 6:30 PM

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements
Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and
Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days on or before 02/28/2025:
1. LIC 500 Personnel Report-Requested
2. LIC 610 Emergency & Disaster Plan-Requested
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)-Requested
4. LIC 309 Administrative Organization -Requested
5. LIC 308 Designation of Administrative Responsibility- Requested
6. LIC200A Application form with updates.

The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640
VISIT DATE: 01/28/2025
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· The facility is operating within the terms of the license.
· Ratios were met and appropriate supervision was provided during this inspection. The LPA took a census of 19 children supervised by 3 staff.
· Classrooms were NOT clean, free of hazards and equipped with age-appropriate furniture and equipment in good condition, where the LPA observed the floors and rugs to be unclean. The licensee cleaned the floors and rugs, prior to the LPA leaving the facility.
· No weapons stored at the facility.
· The LPA did not observe a Carbon Monoxide or Smoke alarm in the classrooms. The facility did have fire extinguishers which were in the green.
· 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.
· Medications are stored where inaccessible to children in the director’s office.
· Hazards are NOT stored where inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are NOT locked in the children’s classrooms where bleach jugs, wipes, toilet and floor cleaners, surface cleaners and air fresheners are stored in upper and lower cabinets.
· All floors and rugs were not observed to be clean and safe in the children’s classrooms where the floors and rugs were observed to be unclean and unvacuumed. The licensee cleaned the floors and rugs prior to the LPA exiting the facility.
· Bathrooms were NOT observed to be safe, sanitary and in operating condition where the LPA observed the toilets to be unclean and one toilet to be leaking water.
· Outdoor activity areas/playgrounds are enclosed by appropriate fences, free of hazards and are supplied with age and size appropriate equipment in good condition.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
· Measures are taken to keep the facility free of flies, other insects and rodents
· Food is stored appropriately and protected from contamination.
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair
· Menus are posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Uncontaminated drinking water shall be readily available both indoors and out and provided by tap water, to be determined. The licensee provided an incomplete Lead test report (under review).
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640
VISIT DATE: 01/28/2025
NARRATIVE
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· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has sand.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 04/15/2026,
· Opening and closing staff member’s CPR/First Aid expires on 04/15/2026.
· Director completed Health and Safety Training on 06/26/2024.
· Staff qualifications and files were reviewed and are NOT complete: 2 staff missing proof of Mandated Reporter Training, 2 staff missing Immunization records and LIC503 Health Screening, The director and Assistant Directors are missing proof of Administrative units.
· Staff have received on the job training for housekeeping, sanitation and universal health precautions.
· Licensee was informed the Department has inspection authority per Health and Safety Codes.
· Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
· Children files were reviewed and are complete are NOT complete: 2 children were missing proof of Immunization records and 3 children were missing the LIC701 Physician’s Reports.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 09/2024.
· Lead Testing: completed on 11/15/2022, however records are under review.
· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care 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 child care and development services online portal for families and providers by June 30, 2022.
This facility provides Incidental Medical Services – IMS. LPA Susan Brewer, reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640
VISIT DATE: 01/28/2025
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 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: http://www.ada.gov/childqanda.htm

The Assistant Director Arilda Espinoza was reminded that all adults 18 and over working including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Susan Brewer informed the Assistant Director Arilda Espinoza of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Deficiencies were cited this visit for Type A and Type B violations

Civil Penalties were not cited this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Assistant Director Arilda Espinoza.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 01/28/2025 05:03 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/28/2025 at 03:53 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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in LPA observed, bleach bottles, bleach wipes, toilet and floor cleaners, air freshners stored in unlocked lower classroom cabinets and upper classroom which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/30/2025
Plan of Correction
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The licensee agrees to ensure all isinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. The licensee also agrees to provide proof of removing the items and relocating where inaccessible to children, by photo or video.
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.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/28/2025 05:03 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/28/2025 at 03:53 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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in the licensee was unable to provide proof of a smoke alarms or carbon monoxide detectors in the children's classrooms, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
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The licensee agrees to ensure the child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. The licensee agrees to provide proof of the smoke alarms and carbon monoxide detector receipts of purchase and submit to the department by photo or video.
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the LPA observed one child toilet leaking water onto the floor, surrounding the toilet which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
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The licensee agrees to provide proof of a work order to repair the leak for the child's toilet by photo.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


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Document Has Been Signed on 01/28/2025 05:03 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/28/2025 at 03:53 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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 staff were missing proof of renewed Mandated reporter training certificates which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The licensee agrees to ensure that a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training and submit proof by fax, mail or e-mail.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 staff members were missing proof of immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The licensee agrees to provide proof of immunizations for subject staff on or before 02/28/2024 by fax, mail or e-mail.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


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Document Has Been Signed on 01/28/2025 05:03 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/28/2025 at 03:53 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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

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 record review, the licensee did not comply with the section cited above in 1 staff is missing the TB screening which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The licensee agrees to submit proof of 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 and ensure all staff obtain a TB screening.
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on record review, the licensee did not comply with the section cited above in 2 staff were missing LIC501 Health screenings which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The licensee agrees to ensure all staff shall have a health-screening report signed by the person performing the screening, and submit proof of health screenings as required by fax, mail or e-mail.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


LIC809 (FAS) - (06/04)
Page: 8 of 13
Document Has Been Signed on 01/28/2025 05:03 PM - It Cannot Be Edited


Created By: Susan Brewer On 01/28/2025 at 03:53 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: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812640

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 children were missing proof of Physician's reports which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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2
3
4
The licensee agrees to obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. The licensee agrees to submit proof of missing medical assessments by fax, mail or e-mail.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 children were missing proof of immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
1
2
3
4
The licensee agrees to ensure each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled and submit proof of missing records by fax, mail or e-mail.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


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