364846188-4-13-2023-09-CC-CCAD-CQV22M-20230413170057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846188
Report Date: 04/13/2023
Date Signed: 04/13/2023 05:01:18 PM

Document Has Been Signed on 04/13/2023 05:01 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KIDDIE ACADEMY OF RANCHO CUCAMONGA		FACILITY NUMBER:	364846188
ADMINISTRATOR:	ASHLEE STUEHRMANN		FACILITY TYPE:	850
ADDRESS:	7220 VICTORIA PARK LANE		TELEPHONE:	(909) 891-8700
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91739
CAPACITY: 127	TOTAL ENROLLED CHILDREN: 90	CENSUS: 50	DATE:	04/13/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:55 PM
MET WITH:	Ashlee Stuehrmann		TIME COMPLETED:	05:10 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 04/10/2023. Licensing Program Analyst Claudia Caywood (LPA) and Licensing Program Manager (LPM) Aaron Ross toured the facility, reviewed documents, and conducted interviews with pertinent parties. LPA took photos of where the incident took place.

Based on information gathered, the facility acted appropriately and no violations have been identified. The facility provided temporary medical attention.The Director immediately called parent, called 911, and reported the incident in a timely manner. The facility implemented precautionary measures to prevent future incidents.

An exit interview was conducted and a copy of this report was provided to facility staff.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1