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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845370
Report Date: 06/20/2025
Date Signed: 06/20/2025 01:58:04 PM

Document Has Been Signed on 06/20/2025 01:58 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:KIDDIE ACADEMYFACILITY NUMBER:
364845370
ADMINISTRATOR/
DIRECTOR:		PAMELA FOXFACILITY TYPE:
850
ADDRESS:15861 POMONA RINCON ROADTELEPHONE:
(909) 529-6661
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 81DATE:
06/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Pamela FoxTIME VISIT/
INSPECTION COMPLETED:
02:07 PM
NARRATIVE
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On the date and time listed above, Licensing Program Analyst (LPA) Chase Atherton, arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility on 5/2/2025 & 6/20/2025.

During the above inspection dates LPA made observations, conducted interviews with pertinent parties, reviewed records, and reviewed video footage.

While conducting an inspection on 5/2/2025 & 6/20/2025, it was disclosed that Child 1 (C1) had a chronic biting behavior. Information gathered stated that between the dates of 2/18/2025 & 4/23/2025 there were at least 9 biting incidents involving C1 as the child who bit another child; 2 biting incidents occurred in the month of February and 7 biting incidents occurred in the month of April. Information gathered stated there were three days in April where C1 bit another child 2 times. The biting incidents were documented on Biting Reports which were signed by the staff and authorized representatives. Information gathered stated 4 of the 9 biting incidents broke the skin of the person who was bitten. Additionally, information gathered stated that staff were given general instructions to keep an eye on C1’s biting behavior, however there was no formal explanation of steps to take to reduce how often C1 was biting. At the time of these incidents, nothing substantial had been implemented in order to reduce the amount of biting from C1 or to ensure that all children’s Personal Rights were not being violated. This does not comply with Title 22 regulations.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: KIDDIE ACADEMY
FACILITY NUMBER: 364845370
VISIT DATE: 06/20/2025
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Additionally, the unusual incident that skin was being broken during child to child biting incidents, was not reported to the Department. The information gathered stated that the facility did react appropriately to the event by administering first aid to the children, but the facility did not submit a report detailing those events to the Department. This does not comply with Title 22 Regulations.

See LIC809D for the deficiencies cited
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LPA Chase Atherton informed Facility Representative Pamela Fox that this report dated 6/20/2025 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Chase Atherton informed Facility Representative Pamela Fox to provide a copy of this licensing report dated 6/20/2025 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.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted, and report was reviewed with the facility representative Pamela Fox.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2025 01:58 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/20/2025 at 12:29 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: KIDDIE ACADEMY
FACILITY NUMBER: 364845370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2025
Section Cited
CCR
101233(a)(2)

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101233 Personal Rights – (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidenced by:
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Director agrees to write a written statement (signed and dated) detailing their understanding of CCR Section 101223(a)(2). Director also agrees to write a plan that details what steps the facility will take to prevent further biting for students that bite. The written statement and plan are to be submitted to the Department by the POC due date.
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Based on the interview and record review, their were 9 biting incidents from a single child, 4 of which broke skin, over the course of 3 months. The facility did not implement anything substantial that reduced the amount of biting from C1 or to ensure that all children’s Personal Rights were not being violated, which poses/posed an immediate Personal Rights risk to the 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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/20/2025 01:58 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/20/2025 at 12:41 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: KIDDIE ACADEMY
FACILITY NUMBER: 364845370

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements (d)…during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours…. (1) Events reported shall include the following:… (C) Any unusual incident… that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Director will submit a statement of understanding for CCR regulation 101212(d) to the Department by POC due date.
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Based upon information gathered, the facility did not report an incident occurring on 4/17/2025 involving a child biting another child and breaking skin. This is a potential health and safety 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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2025


LIC809 (FAS) - (06/04)
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