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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300089
Report Date: 06/10/2024
Date Signed: 06/10/2024 01:10:40 PM

Document Has Been Signed on 06/10/2024 01:10 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 CENTERFACILITY NUMBER:
336300089
ADMINISTRATOR/
DIRECTOR:		ANGEL ANTONFACILITY TYPE:
830
ADDRESS:29705 SOLANA WAYTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 31DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Angel Anton TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 06/10/2024 at 9:18 AM, Licensing Program Analysts (LPA) Gabriela Hernandez and Kelli Waters arrived at the facility unannounced, for the purpose of an unrelated incident. LPA Gabriela Hernandez and Kelli Waters were greeted and granted entry into the facility by Assistant Director Shannon Mouser.

During the visit, LPA’s toured physical plant, observed the center was operating within ratio, and noted that the classrooms were adequately staffed. At 9:35 am, LPAs observed C1 sleeping in the crib on his back, swaddled with muslin blanket covering both arms. The infant was not able to move their arms. LPAs notified Assistant Director immediately, Assistant Director removed the blanket from the child’s body.

Licensee will be cited under California Code of Regulations and Title 22, regarding Infant Care Activities, specifically Infant Safe Sleep.

See 809-D for cited deficiency.

During the exit interview, Appeal Rights were discussed and a copy of this report was reviewed. The Director was given a copy of both documents .

A Notice of Site Visit was issued and must remain posted for the next 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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 06/10/2024 01:10 PM - It Cannot Be Edited


Created By: Gabriela Hernandez On 06/10/2024 at 12:31 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 CENTER
FACILITY NUMBER: 336300089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2024
Section Cited
CCR
10430(3)(C)

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101430 Infant Care Activities
(3)All infants shall be given the opportunity to sleep without...(C) An infant shall not be swaddled while in care.
This requirement has not been met as evidenced by:
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Assistant Director removed blanket from child. Director will complete a training on infant safe sleep and provide proof that staff have attended the training.
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Based on observation, LPA's witnessed C1 was sleeping in crib on their back, swaddled with a muslin blanket covering both arms. This poses a potential health and safety risk to 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
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