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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814893
Report Date: 06/10/2024
Date Signed: 06/10/2024 04:12:26 PM

Document Has Been Signed on 06/10/2024 04:12 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABC CHILD CARE VILLAGEFACILITY NUMBER:
334814893
ADMINISTRATOR/
DIRECTOR:		ANGELINE ANTON (ANGEL)FACILITY TYPE:
850
ADDRESS:40045 VILLAGE ROADTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 216TOTAL ENROLLED CHILDREN: 216CENSUS: 145DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Candice LawrenceTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 06/10/2024 at 1:50 pm, Licensing Program Analysts (LPAs ) Gabriela Hernandez and Kelli Waters conducted an unannounced case management visit in regards to an unusual incident report received on 04/30/24. LPAs met with Director Candice Lawrence.

Per incident report and interview with Director, C1 was sitting and eating at the table when he fell forward out of the chair and hit the right side of his face. Per Director, they are unsure if C1 hit his head on the table or the ground. S1 and S2 attended to C1. Per Director, mother of C1 was notified and child was taken to the Doctors office out of a precaution. Per mother of C1, Doctor confirmed C1 did not sustain a concussion. The child returned to the facility the next day and there were no restrictions.

Per Director, S1 and S2 were the teachers assigned to the classroom and both teachers no longer work at the center.

Based on all the information obtained by LPA, there did not appear to be any violations of Title 22 Regulations pertaining to the reported incident.

An exit an interview was conducted. A copy of this report and appeal rights were provided at the time visit.

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

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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