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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845371
Report Date: 11/20/2024
Date Signed: 11/20/2024 02:41:29 PM

Document Has Been Signed on 11/20/2024 02:41 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:
364845371
ADMINISTRATOR/
DIRECTOR:		PAMELA FOXFACILITY TYPE:
830
ADDRESS:15861 POMONA RINCON ROADTELEPHONE:
(909) 529-6661
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
11/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:41 PM
MET WITH:Pamela Fox, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) for the facility. The UIR was received by the licensing agency on 10/31/2024.

Facility records were reviewed, and staff and director interviewed. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

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.

An exit interview was conducted, and a copy of this report was provided to director, Pamela Fox.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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