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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842337
Report Date: 06/20/2019
Date Signed: 06/20/2019 10:53:45 AM

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:CHILDRENS LIGHTHOUSE LEARNING CENTERFACILITY NUMBER:
334842337
ADMINISTRATOR:LAFLOWER, CASSANDRAFACILITY TYPE:
840
ADDRESS:23656 CLINTON KEITH ROADTELEPHONE:
(951) 600-9395
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:45CENSUS: 4DATE:
06/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
06:45 AM
MET WITH:Millie LeeTIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analysts (LPAs) James Wilkerson and Giselle Carbullido arrived at this facility to follow-up on an incident that that had not been reported as required per Title 22 Regulations. The incident occurred on 06/05/19 when a child threw a rock at another child, hitting the child on the head causing bleeding. The child who was hit in the head required medical attention. This incident was not relayed to Community Care Licensing.

See LIC 809D for deficiency cited per Title 22 Regulations.

An exit interview was conducted and appeal rights discussed and provided along with a copy of this report to Ms. Catlett.

A copy of this report must be made available, upon request for three years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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: CHILDRENS LIGHTHOUSE LEARNING CENTER
FACILITY NUMBER: 334842337
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2019
Section Cited
CCR
101212(d)(1)(B)
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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in
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Licensee, Millie Lee agrees to submit an Unusual Incident Report to Community Care Licensing by close of by close of business on 07/19/19,
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(d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any injury to any child that requires medical treatment. This requirement was not met as evidenced by: A child got hit on the head with a rock, requiring medical attention and it was not reported.
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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: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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