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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845425
Report Date: 11/20/2024
Date Signed: 11/20/2024 03:28:15 PM

Document Has Been Signed on 11/20/2024 03:28 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PENA-BRISENO FAMILY CHILD CAREFACILITY NUMBER:
334845425
ADMINISTRATOR/
DIRECTOR:		AMBAR PENA-BRISENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 246-8800
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Licensee Ambar BrisenoTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On the above date and time Licensing Program Analyst Susan Brewer arrived at the facility for the purpose of conducting an inspection for a separate matter. A case management inspection was conducted due to violations observed and determined on today's date. The LPA was greeted and granted entry into the facility by Licensee Ambar Briseno. The licensee stated no other adults were present and the licensee confirmed they were operating alone.

The LPA conducted a census of 4 children present at the time of arrival. Additional children arrived during the inspection. The LPA observed 7 children in care at 9:12 AM, with 4 daycare children present under the age of 2 years old and 3 children present under the age of 4 years old. Another adult arrived to assist the licensee at 9:45 AM. The LPA determined a violation for non-compliance of the Capacity and Ratio, due to the ages of the children in care and the licensee operating alone, without an assistant.

Information gathered by the LPA through interviews with pertinent parties and with the Licensee, confirmed that the licensee moved out of the licensed home on 12/16/2023. In addition, the licensee did not notify changes to the department regarding the new residency and continued to operate at the licensed daycare. The LPA determined the licensee was in violation for non-compliance of Reporting Requirements. During the inspection the Licensee Ambar Briseno surrendered their original license to the LPA Susan Brewer.

LPA Susan Brewer informed licensee Ambar Pena-Briseno that this report dated 11/20/2024 documents 2 Type A citations, which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.

See LIC809C Page 2
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425
VISIT DATE: 11/20/2024
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Also, LPA Susan Brewer informed the licensee Ambar Pena-Briseno to provide a copy of this licensing report dated 11/20/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Citations were issued for 2 Type A violations of 102416.5(a) Staffing Ratio and Capacity and 102416.2(a)(2) Reporting Requirements.

No civil penalties were issued on today's date.

Exit interview conducted, a report was reviewed and a copy was left with the licensee Ambar Pena-Briseno.

A notice of site visit was given and must remain posted for 30 days. The licensee was reminded that a $100.00 civil penalty will assessed for the removal of the notice of site visit, before the 30 days.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/20/2024 03:28 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/20/2024 at 02:21 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2024
Section Cited
CCR
102416.5(a)

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102416.5(a) Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time

This regulation was not met as evidenced by:
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The licensee agrees to submit a statement of understanding the regulation 102416.5(a) Staffing Ratio and Capacity, and develop a plan to ensure they do not exceed the operating beyond the terms of a license in the future.
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Based on LPA observations of the licensee operating beyond the terms of the licensed daycare ratio and capacity, by supervising 4 children under age 2 years and 3 children under age 4 years without and assistant, which is an immediate risk to the health & safety of children in care.
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The licensee also agrees to submit the written statement on or before 11/21/2024, by fax, mail or e-mail.
Type A
11/21/2024
Section Cited
CCR102416.2(a)(2)

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102416.2(a)(2) Reporting Requirements, The licensee shall report the following information the Department by telephone or fax within the Department's next business day... (2) Any change in household composition including adults moving in or out of the home...
This regulation was not met as evidenced by:
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The licensee agrees to submit a statement of understanding the regulation regarding 102416.2(a)(2) Reporting Requirements and submit the written statement on or before 11/21/2024, by fax, mail or e-mail.
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Based on LPA observations, interviews conducted with pertinent parties and by the licensee's own admission, the licensee failed to report they moved out of the home as of 12/16/2023 and live in at a separate address, which is an immediate risk to the health and safety of children 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:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2024


LIC809 (FAS) - (06/04)
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