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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805816
Report Date: 06/23/2023
Date Signed: 06/23/2023 10:42:54 AM


Document Has Been Signed on 06/23/2023 10:42 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LIFE CHRISTIAN ACADEMYFACILITY NUMBER:
334805816
ADMINISTRATOR:CANDICE LUCKETT-JACKFACILITY TYPE:
850
ADDRESS:3270 RUBIDOUX BLVD.TELEPHONE:
(951) 684-3639
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:60CENSUS: 10DATE:
06/23/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Acting Director Kimberly FrederiqueTIME COMPLETED:
11:00 AM
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On 06/23/2023, Licensing Program Analysts (LPAs) Raymond Moorehead and Rachel Zeron conducted a case management inspection due to required lead testing requirements based on lead testing results received on the facility. LPAs toured the "Green" Room, took census and met with Kimberly Frederique, Acting Director to further discuss lead results received and measures taken for remediation of lead exceedance.

During the inspection, LPAs toured and observed the following water outlet identified with lead exceedance: Outlet A (tested at 17.0 ppb) was identified; Outlet A is designated as a hand washing only faucet that is located inside of the isolation room which is in the facility's front office.

The sink will be used for hand washing only, it is not used for consumption or food preparation. Children bring their own water bottles from home and/or use cups that the facility provides, the facility provides bottled water for the children.

No deficiencies were cited. An exit interview was conducted, and a copy of this report and a Notice of Site Visit (required to be posted for the next 30 days) was provided to the Acting Director Kimberly Frederique on 06/23/2023. LPAs verified the Notice of Site Visit was posted in a prominent location before leaving the facility.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Raymond MooreheadTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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