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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844834
Report Date: 03/05/2026
Date Signed: 03/05/2026 03:31:47 PM

Document Has Been Signed on 03/05/2026 03:31 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:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
334844834
ADMINISTRATOR/
DIRECTOR:		ADAMS,DONISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 430-5012
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY: 14TOTAL ENROLLED CHILDREN: 21CENSUS: 10DATE:
03/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Donisha AdamsTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Sandra Pulido conducted an unannounced annual inspection for a large family childcare at the above home on 03/05/26 at 1:35 PM. LPA met with licensee Donisha Adams, who guided LPA on a tour of the home. There were two children present with Licensee and Assistant when LPA arrived. During the visit, the facility had 21 children enrolled. By the end of the inspection, there were 10 children present.

The facility operates Monday through Friday from 6:00 AM to 6:00 PM each day. Certain areas are off-limits, including the entire second floor, downstairs bedroom/office, and garage. The facility is licensed as a large Family Child Care Home (FCCH) with a maximum capacity of fourteen children and is operating within the licensed capacity of the license. The fire clearance for a large family child care was approved on 11/5/18 by the City of Lake Elsinore Fire Department.

A working cell phone is available, and the current phone number on file is correct. A fully charged fire extinguisher (2A:10BC) was observed, along with a functioning smoke detector and carbon monoxide detector, both of which were tested by the Licensee. All hazardous items, including toxins, are stored securely and are inaccessible to children. No weapons are present, and the Licensee, Donisha Adams, understands that all firearms, weapons, and ammunition must be locked separately and made inaccessible as per Title 22 Regulations. Stairs are barricaded with a gate when children are in care.

The facility provides clean, safe, and age-appropriate toys for children. A current roster is on file, and required postings, including the Facility Sketch, Emergency Disaster Plan, and Notification of Parent’s

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Sandra Pulido
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 334844834
VISIT DATE: 03/05/2026
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Rights, are displayed. Fire and disaster drill documentation is maintained, with the last drill conducted on 01/06/26.

There is an in-ground pool in the backyard of the home. There is a sturdy mesh fence, with a self-latching, self-closing gate with a key-lockable device. LPA verified the gate opens away from the pool. The right side of the pool has a retaining wall consisting of concrete blocks, however, additional fencing was added to ensure it met Title 22 Regulations and the pool is fully enclosed. LPA confirmed there is a pool alarm installed in the pool that is in compliance with ASTM International Standard F2208. LPA confirmed the pool alarm was in the pool and in working order. Documentation confirmed the pool alarm meets the required compliance. LPA verified there is a life ring approved by the U.S. Coast Guard. LPA observed the required rescue pole with a hook. LPA verified there are no windows or doors with direct access into the pool. LPA advised licensee to be vigilant of any wear and tear on the fencing, gate, spring and latch and ensure it continues to meet requirements. LPA verified a daily pool inspection log to be maintained on days of operation to ensure all safety measures are in place before the facility opens. Licensee understands that all bodies of water including ponds, above ground pools, spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar products must be emptied immediately after use and stored in an upright position.

Both children's and employees' records are complete. Mandated Reporter Training has been completed and is valid until 11/13/26. The Pediatric CPR and First Aid certification expires on 08/09/27. Resident and staff records were reviewed, and all adults requiring caregiver background checks have received the necessary clearances and exemptions.

Licensee Donisha Adams was reminded that all adults 18 and over, living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee Donisha Adams and discussed the Child Care

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Sandra Pulido
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ADAMS FAMILY CHILD CARE
FACILITY NUMBER: 334844834
VISIT DATE: 03/05/2026
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Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200. All Unusual Incident Reports can be submitted online at UnusualIncidentReportsDO10@dss.ca.gov.



During the exit interview, the Licensee, Donisha Adams, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process for CARE tools, please send the email inquiries 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.


There are no deficiencies being cited at this time. A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and a copy of this report was reviewed with and handed to Licensee Donisha Adams. Appeal rights were discussed and provided during the exit interview.
NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Sandra Pulido
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5