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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841842
Report Date: 11/03/2022
Date Signed: 11/04/2022 09:41:50 AM

Document Has Been Signed on 11/04/2022 09:41 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KIDDIE ACADEMY OF MURRIETAFACILITY NUMBER:
334841842
ADMINISTRATOR:ELIZABETH SRONCE HOLMESFACILITY TYPE:
850
ADDRESS:41755 JUNIPER STREETTELEPHONE:
(951) 600-0545
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 108TOTAL ENROLLED CHILDREN: 82CENSUS: 59DATE:
11/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Sarah LeibfreidTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA James Wilkerson arrived at this facility 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 10/19/22. It indicates that a child was running on the playground and ran into a side of the building resulting in a cut above the left eyebrow. The injury did result in stitches and a parent was contacted immediately.

Based on the information received during the interview, there was not a lack of supervision as a staff member observed the incident and couldn't react quick enough to prevent it from occurring.

An exit interview was conducted, a Notice of Site Visit posted, appeal rights discussed and provided along with acopy of this report on this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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