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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846289
Report Date: 09/18/2025
Date Signed: 09/18/2025 04:54:10 PM

Document Has Been Signed on 09/18/2025 04:54 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:LIL' BLUE HEARTWOOD PRESCHOOLFACILITY NUMBER:
364846289
ADMINISTRATOR/
DIRECTOR:		FANNY TOPETEFACILITY TYPE:
850
ADDRESS:2460 S EUCLID AVETELEPHONE:
(909) 988-5049
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 18DATE:
09/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Gisell Pulido, director & Fernando Chavez, owner TIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA), Aman Lama arrived at the center to conduct an annual inspection. LPA was met with licensee, Fernando Chavez. The center has 2 preschool classrooms, which were all inspected on this date. The center also has an infant program, which was not inspected on this date. LPA toured inside and outside, and the following was observed and/or noted:

The following documents are requested to be updated if any changes made, and submit to the Riverside Regional Office (RRO) within 30 days of this report:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan (collected during todays inspection)
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Food menu.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
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 14
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 14
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289
VISIT DATE: 09/18/2025
NARRATIVE
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·The facility is operating within the limits as stated on the license.
  • Appropriate fire extinguisher and working carbon monoxide and smoke detector were all observed.
· Ratios were met during this inspection.
· Classrooms are adequately equipped with age and size appropriate furniture. Hazards were observed and noted on an LIC809D.
· There are no weapons present at the facility.
· No accessible bodies of water were observed by LPA at the time of this inspection. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children bring their own water bottles/cups from home. There are water fountains on the property, but children do not utilize them for drinking water. There is a water dispenser in the kitchen with uncontaminated drinking water, and staff will refill bottles, as needed.
· Hazards were observed stored where they were accessible to children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care.
· Poisons and toxins are to be kept locked and were observed accessible, per Title 22 Regulations.
· All floors were observed clean, safe, and shall remain so at all times.
· Restrooms were observed to be sanitary and in operating condition.
· Playgrounds are enclosed by appropriate fences-SEE LIC809D for concerns.
· Outdoor activity areas are in fair condition and supplied with age/size appropriate equipment.
· The areas around or under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs a fall.
· Food is provided by the center, kitchen was observed in compliance with Title 22 Regulations.
· There were two trash bins observed in the Cheerioes classroom. One without a lid, due to it being broken and another with a lid. The one without a lid was not in compliance with Title 22- SEE LIC809D
· Sign in/Sign out record was reviewed and meets regulation requirements.
· There is at least one closing and one opening staff present with a current CPR/First Aid on file.
· A review of children’s records were found to be incomplete during this inspection.
· The center was unable to provide proof of disaster drills, which are to be conducted every six months.
· The facility is informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. However, 1 out of 4 staff were not on the facility roster.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
Page: 3 of 14
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289
VISIT DATE: 09/18/2025
NARRATIVE
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·The facility can submit transfer forms to associate or disassociate someone from their facility at: Associations_Disassociations862@dss.ca.gov
· A review of staff records indicates that staff that were present meet minimum qualifications for the position for which they were hired.

-This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
For IMS information see PIN 22-02-CCP.

-The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

- Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

- To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200



Licensee Fernando Chavez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Fernando Chavez confirmed that there are no Registered Sex Offenders living in the facility. LPA completed the RSO profile in FAS.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Fernando Chavez.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Aman Lama
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)(1)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During a tour of the center, LPA noted the following items in an unlocked cabinet, accessible on the most bottom shelf: 1 bag of "Pure Epsom Salt", 1 bag of "Epsom Salt", 8fl Oz bottle of Tide detergent, 2 cans of shaving cream, and 1 64 fl Oz bottle of "Sta-Flo, concentrated liquid starch". This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Director immediately removed these items and placed them on top of the cabinet. The facility representative agrees to submit proof of these items inaccessible behind a key lock, no later than POC due date.
Type A
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the tour, LPA observed the trash can without a lid having food waste in it. A child was observed with their hand in the trash can. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Immediately, director removed the contents of the trash can without the lid and placed a new liner in it. This trash can was swapped with a trash can with a lid on it, which was next to the hand-washing sink, with nothing but paper towels in them.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 5 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During a tour of the outdoor area, LPA observed a large hole in the ground where a tree used to be. This hole is approximately 3'8" in width in size, and approximately 1 foot deep, if not a little more. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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The director agrees to submit proof of this being barricaded or the hole being filled. No later than the POC due date, facility representative agrees to submit a written plan for the area.
Type A
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Several(5-10) children in the "cheerioes" classroom were observed running into the restroom by themselves, throughout the day. Staff were indicating to the children to let them know when they're done. Furthermore, during transition from the outdoor area to indoor area, there were approximately 3-7 children indoors, and staff had their back to them until one of the children started to cry. This poses an immediate health, safety/personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Facility representative agrees to read through the regulation and submit their understanding of the regulation. This is due to the department no later than the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 6 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on directors own admission, the facility did not have any documentation of disaster drills available for review. Director also stated that she recalls the disaster drills being done sometime in January, but have not done any since then. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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The facility agrees to begin implementing a disaster drill log, and conduct disaster drills with all the children immediately. These drills are to be conducted at least every 6 months. Documentation shall be submitted to the department no later than the POC due date.
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the facility tour, LPA observed 3 containers of disinfecting wipes, and an unlabeled cleaning spray. These were stored in a cabinet with the door closed, but not locked. The shelf they were on was low enough for daycare children to access. Director understands the difference between having 1 item in an inaccessible area for use, vs 'storing' multiple containers, not behind a key lock. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2025
Plan of Correction
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These were immediately removed and placed in a higher area. The extras were taken out during todays inspection.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 7 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(o)
Fixtures, Furniture, Equipment and Supplies
(o) Playground equipment shall be securely anchored to the ground unless it is portable by design.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during the tour, LPA noted that none of the plastic play structures outdoors were bolted or weighed down. LPA was able to move them by pushing them with not much force. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2025
Plan of Correction
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The facility agrees to immediately make this play area a safe area, by either weighing the structures down, or bolting them down. LPA will return at a later time to ensure this area is in compliance.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. 1 out of 4 staff (S1) files did not have their Mandated Reporter Training (MRT) for "Child Care Providers" certificate updated. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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The facility representative agrees to submit proof of MRT certificate for S1, no later than the POC due date. This training can be accessed online at mandatedreporterca.com
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 8 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, 2 out of 4 staff (S1 and S4) did not have a health-screening report (OR LIC503) on file for review during this inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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2
3
4
Facility representative agrees to submit proof of LIC503 or similar, for S1 and S4, to licensing no later than the POC due date.
Type B
Section Cited
CCR
101217(a)(14)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (14) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 101170(e).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
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3
4
Based on record reveiw,1 out of 4 staff were not on the facility roster. However, their fingerprints have been cleared, they were just never transferred and associated to this facility. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2025
Plan of Correction
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2
3
4
The facility representative agrees to put S3 on the facility roster ASAP. Communication of this via voice message, text message or email must be received no later than the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 9 of 14
Document Has Been Signed on 09/18/2025 04:54 PM - It Cannot Be Edited


Created By: Aman Lama On 09/18/2025 at 03:36 PM
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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, 1 out of 6 children (C5) did not have a written medical assessment of the child on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2025
Plan of Correction
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Facility representative agrees to obtain a written medical assessment for C5 and place in their file. LPA will return at a later time to review.
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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During a previous visit, LPA discovered there was a change in director for the center. This change had taken place well over the 10 days allotted, and was never communicated to LPA. LPA had requested the new appointed director submit a directors packet, which has still not been received. LPA reviewed what was available, and left the center with a list of missing items. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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Facility representative agrees to submit a directors packet for the new appointed director, no later than the POC due date. This is due to licensing, no later than the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


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