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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814895
Report Date: 12/27/2024
Date Signed: 12/27/2024 01:16:50 PM

Document Has Been Signed on 12/27/2024 01:16 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:
334814895
ADMINISTRATOR/
DIRECTOR:		ANGELINE ANTON (ANGEL)FACILITY TYPE:
830
ADDRESS:40045 VILLAGE ROADTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 23DATE:
12/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:34 PM
MET WITH:Facility Representative Candice Lawrence TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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 On date and time listed, Licensing Program Analyst (LPA) Kelly Gerth conducted a separate unannounced visit at the Child Care Center (CCC) ABC Childcare Village.
During the visit, LPA Gerth reviewed records and toured the facility with Facility Representative Candice Lawrence. The following health and safety concerns were observed during file review, which resulted in a separate case management visit.
On December 17, 2024 three incidents resulting in three separate staff disciplinary actions occurred, where interviews, file reviews and the disciplinary actions revealed that three staff members were found to have violated the personal rights of infants in care.

Further staff interviews and file review confirmed that Community Care Licensing (CCL) was not notified of these incidents within 24 hours via telephone and no record of an Unusual Incident Report (UIR) was neither mailed or emailed to CCL within seven (7) days.
Based on records review, staff interview and LPA observations, the facility is being cited for: Title 22, division 12, Chapter 1, Article 06, section: 101212(d)(1)(C) Reporting Requirements,

see 809D for deficiencies.
In addition, LPA has requested that the CCC submit an updated LIC 500 to CCL within 7 working days, reflecting all current staff to include a full time, fully qualified director.

Exit interview was conducted, and a copy of this report, 809D and appeal rights were provided to Facility Representative Candice Lawrence. A notice of site visit was provided and licensee was informed it must be posted for 30 consecutive days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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Document Has Been Signed on 12/27/2024 01:16 PM - It Cannot Be Edited


Created By: Kelly Gerth On 12/27/2024 at 12:54 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ABC CHILD CARE VILLAGE
FACILITY NUMBER: 334814895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2025
Section Cited
CCR
101212(d)(1)(C)

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Reporting Requirements:(d) Upon the occurrence.... a report shall be made to the Department.....by next working day. In addition, a written report....shall be submitted to the Department within seven days........
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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By COB, Owner/Director will email LPA Gerth, an admin training on 101212 Reporting requirements, including a staff sign-in and written statement of understanding.
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Based on interview and record review, the licensee did not comply with the section cited above where the Director did not report incidents to CCL in a timely manner. Where the personal rights of three child were jeopardized by staff members, on 12/17/2024, Which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2024


LIC809 (FAS) - (06/04)
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