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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818384
Report Date: 07/18/2019
Date Signed: 07/18/2019 08:47:53 PM

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:DISCOVERY ISLE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334818384
ADMINISTRATOR:KERR, ASHLEYFACILITY TYPE:
850
ADDRESS:23785 WASHINGTON AVETELEPHONE:
(951) 304-3033
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:120CENSUS: 43DATE:
07/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Melissa Almanza, Assistant PrincipalTIME COMPLETED:
10:30 PM
NARRATIVE
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On the date and time listed above, during the complaint investigation conducted on 07/18/2019 by Licensing Program Analyst's (LPA), Giselle Carbullido, the following was observed:

While reviewing documentation: The current admission agreement does not address conditions for termination/disenrollment.

Per California Code of Regulations, Title 22, Div. 12., Regulation 101219(b)(7) states : Admission agreements shall specify the following: Conditions under which the agreement may be terminated.

See LIC 809D for cited deficiency of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted with Licensee and a copy of this report was given to Licensee.

Appeal rights issued and discussed with licensee. A copy of this report must be made available to the public upon request for three years.

Notice of Site visit issued, and LPAs observed posting of notice. Acknowledgment of receipt provided.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 505-6432
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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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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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DISCOVERY ISLE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 334818384
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2019
Section Cited
CCR
101219(b)(7)
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Admission Agreement: Admission agreements shall specify the following: Conditions under which the agreement may be terminated. This requiremnt was not met as evidenced by Admission agreement only addresses tuition conditions.
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:Licensee agrees to submit an updated admission agreement addressing all conditions for termination of services or disenrollment by POC due date.
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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 505-6432
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
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