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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845371
Report Date: 01/14/2025
Date Signed: 01/14/2025 10:29:24 AM

Document Has Been Signed on 01/14/2025 10:29 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: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: 17DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Pamela Fox, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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On 1/14/25, at 9: 35 AM/PM Licensing Program Analyst (LPA), Claudia Caywood conducted a case management visit to conclude an investigation to a self-reported unusual incident report (UIR). The UIR was initially received by the licensing agency on 11/4/24. The UIR states on 10/30/24 a staff member aggressively pulled a child away from another child causing the child to fall over then dragged the child over to their self.. On 11/20/24, LPA conducted a Case Management visit where LPA conducted interviews, reviewed video footage, and obtained documents. During today’s visit, LPA met with Pamela Fox, toured the facility, and took census.

During the investigation of the UIR, LPA viewed video footage of the incident. LPA observed a teacher pulling a child over to their self to prevent the child from grabbing another child’s face. In the video, a staff member was observed pulling a child over to their self in an inappropriate manner. The staff member was observed pulling the child over to them self instead of walking over to the child and picking them up. This caused the child to topple over as they were being pulled across the carpet. The child did not sustain any visible injuries according to witnesses and video footage.

The video footage shows the director immediately notifying the staff member to not handle the child in this manner and staff member was dismissed of their duties later that same day. The director notified the licensing agency by telephone and submitted a UIR in a timely manner.

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

An exit interview was conducted with Director, Pamela Fox. During the exit interview, appeal rights were discussed/provided, Notice of Site form provided, and a copy of this report was provided.



Notice of Site visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
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 10:29 AM - It Cannot Be Edited


Created By: Claudia Caywood On 01/14/2025 at 10:10 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: KIDDIE ACADEMY
FACILITY NUMBER: 364845371

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2025
Section Cited
CCR
101223(a)(3)

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Personal Rights: 101223(a)(3)(a)The licensee shall ensure... is accorded... personal rights:(3) To be free from corporal or unusual punishment, ... not limited to: ...daily living including eating, sleeping...physicalfunctioning.This requirement was not met as evidencedby:

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Director agreed to review the Personal Rights section 101223(a)(3) with staff and provide a signed document statement they understand this section of the personal rights CCR by the POC due date of 1/15/2025
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Based on LPA interviews and records review. LPA observed video footage of staff pulling a child in an inappropriate manner which posed a potential health, safety, or 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.
SUPERVISOR'S NAME:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
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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