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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841081
Report Date: 09/23/2021
Date Signed: 09/23/2021 11:44:37 AM

Document Has Been Signed on 09/23/2021 11:44 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABUNDANT PRESCHOOL OF LEARNINGFACILITY NUMBER:
364841081
ADMINISTRATOR:DOMINIGUE LUCIENFACILITY TYPE:
850
ADDRESS:10900 CIVIC CENTER DRIVETELEPHONE:
(909) 204-4514
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 128TOTAL ENROLLED CHILDREN: 0CENSUS: 61DATE:
09/23/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dominque Lucien/DirectorTIME COMPLETED:
12:10 PM
NARRATIVE
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On 9/23/2021 at 9:45 AM, Licensing Program Analyst (LPA) Patricia Berry conducted a case management/deficiency investigation. LPA was granted access into the facility and met with Dominique Lucien. LPA toured facility and took a census. Director self reported that on 9/14/2021 at 4:30 PM, two children were left out on the playground without any supervision and were on the playground for approximately 2 minutes. Staff stated the class was transitioning into the classroom while parents were picking up children and the children were noticed missing once staff was in the classroom and name to face was taken.

This is an immediate risk to the Health and Safety of children in care.

Deficiency cited on 809D. Civil Penalty LIC42 1IM assessed.

Acknowledgement of receipt and appeal right provided.

LPA observed director post Notice of Site Visit and 809D page.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2021
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 09/23/2021 11:44 AM - It Cannot Be Edited


Created By: Patricia Berry On 09/23/2021 at 10:59 AM
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: ABUNDANT PRESCHOOL OF LEARNING
FACILITY NUMBER: 364841081

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2021
Section Cited
CCR
101229(1)

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Responsibility for Providing Care and Supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement was not met as evidenced by
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Director stated both children were immediately retrieved from the playground 9/14. Director stated she will provide a plan to Community Care Licensing on how during transitions, children will be accounted for and send the plan to CCL by 9/24/21.
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Based on director self-reporting the incident of two children left out on the playground without supervision.
This is an immediate risk to the Health and Safety of children in care. Civil Penalty LIC421IM assessed. Plan of correction discussed with director
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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:Gilbert Sena
LICENSING EVALUATOR NAME:Patricia Berry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2021


LIC809 (FAS) - (06/04)
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