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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845371
Report Date: 03/13/2025
Date Signed: 03/13/2025 10:58:35 AM

Document Has Been Signed on 03/13/2025 10:58 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: 18DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Pamela Fox, Director
Lydia Mena, Assistant Director 		TIME VISIT/
INSPECTION COMPLETED:
11:08 AM
NARRATIVE
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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. It was noted on February 28, 2025 a staff heard a child coughing and when the staff member turned around he/she observed a vape pen in the child’s hand. It was also reported the facility believes the child had the vape pen in his/her mouth which they confirmed from video footage. During interviews conducted by the facility it was determined the vape pen belonged to a staff member that had fallen out of his/her pocket. At the time the child was in possession of the vape, the vape was believed to be locked, therefore, the child could not inhale any of the substance. Management immediately sent the staff member home and initiated the termination process. Additionally, Management contacted the child’s Authorized Representative(s) to inform them of the incident and continued to monitor the child throughout the day. The child did not show any signs of illness and outside medical attention was not received. During interviews conducted by the LPA the information disclosed in the written UIR was confirmed to be true and accurate. Director stated, all teachers were told vapes, cigarettes and lighters were not allowed in the facility and formal Health & Safety training will be conducted. Based on information gathered, the facility acted appropriately, however, a violation of the Title 22 regulation has been identified.

See LIC 809 D for deficiency

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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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: 364845371
VISIT DATE: 03/13/2025
NARRATIVE
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LPA informed Licensee, that this report dated 3-13-2025 documents one Type A citations. Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the safety of children in care. Also, LPA informed the Licensee, to provide an Acknowledgement of Receipt of Licensing Report (LIC 9224), 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 LIC 9224 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 Pamela Fox, Director.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/13/2025 10:58 AM - It Cannot Be Edited


Created By: Elyse Jones On 03/13/2025 at 10:35 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: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/14/2025
Section Cited
CCR
101223(a)

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(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 was not met as evidenced by:
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The Director understands the hazardous items must be made inaccessible to the children in care. Director agrees to write a statement of understanding of the regulation and a plan to ensure an incident like this does not happen in the future. Statement and plan are due on or by 3-14-2025.
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Based on interview and record review, the Licensee did not meet the above regulation which poses an immediate health risk to the children in care. The facility self-reported a child being observed with a vape pen in their possession and believed the vape pen was in the child’s mouth.
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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:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2025


LIC809 (FAS) - (06/04)
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