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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846174
Report Date: 12/09/2022
Date Signed: 12/09/2022 09:50:54 AM

Document Has Been Signed on 12/09/2022 09:50 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FAIRYTALE CASTLE PRESCHOOLFACILITY NUMBER:
364846174
ADMINISTRATOR:LAURA PEREZFACILITY TYPE:
850
ADDRESS:710 EAST FOOTHILL BLVDTELEPHONE:
(626) 567-5678
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY: 116TOTAL ENROLLED CHILDREN: 116CENSUS: 40DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director/Administrator, Wei Zhao,TIME COMPLETED:
10:00 AM
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On 12/09/22 an unannounced case management inspection was conducted by Licensing Program Analysts (LPAs) Blanca Ruiz and Elyse Jones. LPAs met with Lead Teacher, Michelle Phillips, at the time of the inspection and stated the purpose for the visit. LPAs toured the center and a census was taken.

The purpose of the inspection was to deliver an amended licensing report for deficiency cited on August 5, 2022, allegation finding from complaint investigation report has also changed from substantiated to unsubstantiated. During today’s inspection, LPAs delivered the amended report and retrieved the original page.
 
No deficiencies were cited during inspection.
 
An exit interview was conducted with Lead Teacher, Michelle Phillips. A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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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