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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334812819
Report Date: 10/29/2025
Date Signed: 10/29/2025 02:28:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2025 and conducted by Evaluator Sumayya Habeebulla
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20250909091736
FACILITY NAME:FSA-HEMLOCK CDCFACILITY NUMBER:
334812819
ADMINISTRATOR:CYNTHIA OLIVAS FLETCHERFACILITY TYPE:
850
ADDRESS:23270 HEMLOCK AVE.TELEPHONE:
(951) 243-3192
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:110CENSUS: 55DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Cynthia Olivas FletcherTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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- Staff are not taking steps to prevent the spread of communicable disease.
INVESTIGATION FINDINGS:
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived unannounced at the facility and met with Facility Director Ms. Cynthia Olivas to deliver the investigative findings for the above stated allegation.

During the investigation, interviews were conducted with the Facility Director and other pertinent parties. LPA also conducted an inspection of the entire facility.

The first allegation is staff are not taking steps to prevent the spread of communicable disease. It was documented that there were multiple cases of COVID infection cases at the center. The first documented case was in August of 2025, and the last documented case was in September of 2025. Facility had a total number of 8 staff and two children who tested positive for COVID during this time frame.

See LIC 9099C for continuation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 10-CC-20250909091736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-HEMLOCK CDC
FACILITY NUMBER: 334812819
VISIT DATE: 10/29/2025
NARRATIVE
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Interviews revealed staff and students did not attend the facility during the infectious period and only returned to the facility once they tested negative or were symptoms and fever free without medication for over 24 hours. Documentation obtained from the facility revealed facility failed to inform parents, health department, and Licensing about the outbreak and take the necessary steps of sanitizing the affected classrooms and taking the appropriate measures to stop the spread of COVID.

Based on interviews and documentation reviewed, the preponderance of evidence standard has been met, and the allegation is substantiated. The facility failed to report the spread of communicable illness to parents as required by Title 22, Section 101212(f), posing a potential risk to children in care. A citation was issued; please refer to LIC 9099-D for details of the cited deficiency.

An exit interview was conducted, and a copy of the report, along with appeal rights, was provided to the facility Director Cynthia Olivas.

A Notice of Site Visit was also issued and must remain posted for 30 consecutive days in a location visible to the public, families, and guardians.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20250909091736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FSA-HEMLOCK CDC
FACILITY NUMBER: 334812819
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2025
Section Cited
CCR
101212(f)
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(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.
This requirement is not met as evidenced by:
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Facility Director agrees to submit a written statement of the steps that will be taken by the facility to ensure that all required persons are informed of the communicable illness and submit it to the department by the POC due date.
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There were reported COVID + outbreaks among facility staff and students beginning August 21. 2025 until September 11, 2025. Facility failed to notify parents, health department in a timely manner and take the necessary steps to stop the spread of the illness.
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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.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2025 and conducted by Evaluator Sumayya Habeebulla
COMPLAINT CONTROL NUMBER: 10-CC-20250909091736

FACILITY NAME:FSA-HEMLOCK CDCFACILITY NUMBER:
334812819
ADMINISTRATOR:CYNTHIA OLIVAS FLETCHERFACILITY TYPE:
850
ADDRESS:23270 HEMLOCK AVE.TELEPHONE:
(951) 243-3192
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:78CENSUS: 55DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Cynthia Olivas FletcherTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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- Staff did not keep daycare center at a comfortable temperature
INVESTIGATION FINDINGS:
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived unannounced at the facility and met with Facility Director Ms. Cynthia Olivas to deliver the investigative findings for the above stated allegations.

During the investigation, interviews were conducted with the Facility Director and other pertinent parties. LPA also conducted an inspection of the entire facility.

The second allegation Staff did not keep daycare center at a comfortable temperature. Interviews and documentation revealed that the facility staff of Room 2 reported to the facility director that the AC in Room 2 was not cooling. Facility Director placed two portable coolers in the classroom and submitted a work order request to management. The incident occurred on a Friday afternoon.

See LIC 9099C for continuation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 10-CC-20250909091736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-HEMLOCK CDC
FACILITY NUMBER: 334812819
VISIT DATE: 10/29/2025
NARRATIVE
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The AC was fixed and was up and running by Monday afternoon. During the period the AC was not functioning the class had portable air coolers which helped the air to be at a comfortable temperature. As per interviews, there were no reports of staff or children reporting uncomfortable temperatures and unable to be in the classroom due to heat exhaustion.

Based on observations and interviews, there is no sufficient evidence to support the allegation Licensee did not ensure a comfortable environment was provided for day care children.

From the information received through interviews with Facility staff and other pertaining parties, the above allegation cannot be verified. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Facility Director Cynthia Olivas, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5