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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700205
Report Date: 06/03/2022
Date Signed: 06/03/2022 01:35:56 PM

Document Has Been Signed on 06/03/2022 01:35 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:A RISING STAR ACADEMY CHILDCARE CENTER, INC.FACILITY NUMBER:
376700205
ADMINISTRATOR:ROBINSON, DANIELLEFACILITY TYPE:
830
ADDRESS:169 ROYMAR ROADTELEPHONE:
(760) 439-3344
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
06/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Owner Deseree ArmsteadTIME COMPLETED:
01:45 PM
NARRATIVE
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On the above date and time, Licensing Program Analyst (LPA) Jessica Rubio met with Creative Learning Academy (CCC), Owner Deseree Armstead to discuss a case management issue regarding children’s records. On May 3, 2022, LPAs Jessica Rubio and Ana Noble visited the facility and requested to review the file and records for a child (C1), as listed on the LIC 811, Confidential Names List. LPA was informed by staff that they were unsure where the records were and it was possible some records were in a stack of documents along with other children’s documents. LPA reviewed the stack of documents in the facility and a complete file for C1 was not found. C1’s full records were unavailable for review. LPA was later provided an incomplete record for C1. The facility is being cited for Title 22 Regulation Section 101221 (a) Child’s Records. An exit interview was conducted, a copy of this report, LIC 811 and appeal rights were explained and provided to Owner Deseree Armstead. A notice of site visit was also given and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2022
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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Document Has Been Signed on 06/03/2022 01:35 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 06/03/2022 at 12:40 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: A RISING STAR ACADEMY CHILDCARE CENTER, INC.
FACILITY NUMBER: 376700205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2022
Section Cited
CCR
101221

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Child's Records (a) A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by:
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Owner stated she will train staff where the children's files are located and ensure they are accessible to staff and obtain all required documents. Owner will sumbit proof of training to LPA.
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Based on record review, there was not a complete record for C1 maintained in the child care center, which poses a potential health, safety 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022


LIC809 (FAS) - (06/04)
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