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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818374
Report Date: 07/03/2023
Date Signed: 07/03/2023 04:26:38 PM


Document Has Been Signed on 07/03/2023 04:26 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:INLAND VINEYARD PRESCHOOLFACILITY NUMBER:
334818374
ADMINISTRATOR:ANGELA TWYMANFACILITY TYPE:
850
ADDRESS:935 N. MCKINLEYTELEPHONE:
(951) 549-8396
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:133CENSUS: 11DATE:
07/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Angela Twyman, DirectorTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analysts(LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to conduct a Case Management-Deficiencies inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the inspection LPAs observed S1 providing Supervision & Care. S1's Criminal Record Clearance is not associated to the facility or any other facility owned by the Licensee.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
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 2


Document Has Been Signed on 07/03/2023 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: INLAND VINEYARD PRESCHOOL
FACILITY NUMBER: 334818374

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2023
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170 (f).
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have a Criminial Record Clearance associated to the facility. Director stated an email was sent to the Department requesting association, however, the email was unable to be located by the Director.
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This requirement was not evidenced by:
Based on record review, the Licensee did not meet Criminal Record Clearance which poses an immediate Health, Safety & Personal Rights risk to the children in care. During the inspection LPAs observed S1 providing Supervision & Care and did not
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Director agrees to send required documents to the Department to have S1 associated and understands S1 cannot work until S1 is associated.

Civil Penalty assessed. $100 per day for 5 days.

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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 RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2