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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846291
Report Date: 04/24/2023
Date Signed: 04/24/2023 03:27:48 PM

Document Has Been Signed on 04/24/2023 03:27 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LIL' BLUE HEARTWOOD PRESCHOOLFACILITY NUMBER:
364846291
ADMINISTRATOR:FANNY TOPETEFACILITY TYPE:
830
ADDRESS:2460 S EUCLID AVETELEPHONE:
9099885049
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
04/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Fanny TopeteTIME COMPLETED:
03:45 PM
NARRATIVE
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On April 24, 2023 Licensing Program Analyst (LPA) Blanca Ruiz made an unannounced inspection  at the facility to conduct a Case Management visit for the purpose of addressing separate matters that was discovered during an inspection at the facility during the month of February and March 2023. LPA met with Staff, Adriana Topete who granted LPA access into the facility, 15 minutes later Facility Director Fanny Topete arrived to the facility. The facility was toured, and a census was taken. During prior inspections LPA requested Staff Records and /or signing sheets to verify Title 22 compliance. Directors Fanny Topete and Fernando Chavez explained that records were not available for review due to change of ownership in progress including current/ new staff records at the facility (temporary daycare agencies).  Per records review, transferred of ownership was completed the last week of 02/2023. Both licensee's acknowledge that all personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours.  Licensee's submit records for review via e-mail to Community Care Licensing on 03/03/23.

Please See LIC 809-D for deficiency cited

Exit interview conducted and report was reviewed with licensee, Fanny Topete. A Notice of Site Visit was given and must remain posted on, or immediately adjacent to the interior of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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 04/24/2023 03:27 PM - It Cannot Be Edited


Created By: Blanca Ruiz-Silva On 04/24/2023 at 11:31 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: LIL' BLUE HEARTWOOD PRESCHOOL
FACILITY NUMBER: 364846291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
101217(c)

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101217 Personnel Records(c) All personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying... This requirement was not met as evidence by:
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Licensee, Fernando Chavez provided copy of Staff N.3's file to verify compliance with Title 22 regulation on 03/03/2023 additional documents requested were also provided on a later day via e-mail. Letter of Deficiency Cleared was provided during this inspection.
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During LPA's inspection conducted on 02/28/23 and 03/02/2023 : Staff N.3's records were not available for review. Additional sign in/out documentation requested from staff from infant room were unable to populate on 02/28/23 due to computer conflict transferring information from old to current facility. No back up system was in place to be in substantial compliance with CCL. Records were provided on 03/03/23. This is a potential risk to the health, safety and/ or personal rights risk to 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:Aaron Ross
LICENSING EVALUATOR NAME:Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2023


LIC809 (FAS) - (06/04)
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