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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814895
Report Date: 04/07/2023
Date Signed: 04/19/2023 09:14:53 AM

Document Has Been Signed on 04/19/2023 09:14 AM - 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABC CHILD CARE VILLAGEFACILITY NUMBER:
334814895
ADMINISTRATOR:ANGELINE ANTON (ANGEL)FACILITY TYPE:
830
ADDRESS:40045 VILLAGE ROADTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 40DATE:
04/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Angel AntonTIME COMPLETED:
11:45 AM
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On April 7, 2023, LPA's William Chancellor and Anastasia Flores arrived to ABC Village to conduct a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on March 8, 2023. It indicates that a child1 was given the incorrect bottle on March 7, 2023 at 12:30pm.

A tour of the facility, classroom and children's refrigerator where bottles are stored was given by DIR and records were reviewed for child1, child2 and staff1. Based on the information gathered, the facility acted appropriately and no violations have been identified. The facility called the parents of both children involved and neither had any concerns or complaints. Management also reviewed with all caregivers in the infant rooms proper procedures on labeling, storage and dispensing bottles to the correct children where a training was given. Management took extra precaution to also include label's for the individual caregiver per child on the bottle's baskets and changed the placement of the baskets. To decrease the risk of human error in the future, the kitchen helper will place bottles of the same type on different shelves of the refrigerator.

An exit interview was conducted and a copy of this report was provided to the facility staff.

During case management inspection, LPA Chancellor also discussed safe sleep practices.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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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