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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841081
Report Date: 06/24/2024
Date Signed: 06/24/2024 09:39:58 AM

Document Has Been Signed on 06/24/2024 09:39 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABUNDANT PRESCHOOL OF LEARNINGFACILITY NUMBER:
364841081
ADMINISTRATOR/
DIRECTOR:
TIFFANY CAREYFACILITY TYPE:
850
ADDRESS:10900 CIVIC CENTER DRIVETELEPHONE:
(909) 204-4514
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 152TOTAL ENROLLED CHILDREN: 152CENSUS: 24DATE:
06/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Dominque Lucien/Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 6/13/24. It indicates the two children were standing in line to get on the water slide, based on interviews and the LPA’s observation of viewing the video clipping, the two children bumped stomach’s together in a gesture of excitement. When the children bumped stomach’s one child fell backwards into the fence and hit head. Staff called parents and applied first-aid. The child did require medical treatment which resulted in two staples. The child did return to school the following day.

Based on information gathered, the facility acted appropriately, and no violations have been identified. The incident had been determined to be an accident.

An exit interview was conducted and a copy of this report, appeal rights and notice of site visit was provided to facility staff.

Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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