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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841302
Report Date: 01/14/2025
Date Signed: 01/14/2025 09:15:27 AM

Document Has Been Signed on 01/14/2025 09:15 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:CREATIVE KIDS PRESCHOOLFACILITY NUMBER:
364841302
ADMINISTRATOR/
DIRECTOR:		TERESA FORTUNATOFACILITY TYPE:
850
ADDRESS:1161 EAST RIVERSIDE DRIVETELEPHONE:
(909) 923-5006
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 36DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Teresa FortunatoTIME VISIT/
INSPECTION COMPLETED:
09:25 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Chase Atherton and Aman Lama arrived at the facility to follow up on a case management visit that was conducted on 12/26/2024. LPAs met with Director Teresa Fortunato, toured the facility, and took census. The Unusual Incident Report (UIR) was received by the licensing agency on 12/16/2024. It indicates an inappropriate behavior between two children was reported.

Facility records were reviewed, and pertinent parties were interviewed. Based on the information gathered, the facility acted appropriately within the scope of the UIR, and no violations were identified within the scope of the UIR.

However, the following violations were identified during the inspection: based on record review and pertinent party interviews, the facility failed to provide visual supervision while children were using the restroom located outside on the playground on 12/13/2024. LPAs informed the facility director that visual supervision must be provided at all times.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12

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

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Chase Atherton
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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 01/14/2025 09:15 AM - It Cannot Be Edited


Created By: Chase Atherton On 01/14/2025 at 08:38 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: CREATIVE KIDS PRESCHOOL
FACILITY NUMBER: 364841302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in.... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director agrees to provide in-service training to staff regarding Responsibility for Providing Care and Supervision and will submit proof of training, training agenda items, and staff attendance sheet, to the Department by the close of business day February 14, 2025.
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Based on records review (video) and interviews, the facility did not maintain visual supervision of all children which poses/posed a potential health, safety or personal rights risk to persons 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:Chase Atherton
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


LIC809 (FAS) - (06/04)
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