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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841303
Report Date: 09/20/2019
Date Signed: 09/20/2019 06:27:58 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CREATIVE KIDS PRESCHOOLFACILITY NUMBER:
364841303
ADMINISTRATOR:FORTUNATO, TERESAFACILITY TYPE:
840
ADDRESS:1161 E RIVERSIDE DRIVETELEPHONE:
(909) 923-5006
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:56CENSUS: 17DATE:
09/20/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Teresa FortunatoTIME COMPLETED:
06:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Blanca Ruiz-Silva arrived at the facility to follow up on an incident learned during an investigation of complaint 09-CC-20190814170417. Parents of the child involved are aware of the incident.

During the investigation it was learned that Child#1 used bad language, hit, push, throw things, kick staff and other children. In addition, child exposed private area to children in the classroom. Although the incident was handled immediately, the incident made the children feel sad and scared. Licensee failed to report the incident to Community Care Licensing in a timely manner.

The following deficiencies were cited:

101212(d)(1)(C) Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence. The center failed to report the incident of Child#1 to community care licensing (CCL).


Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CREATIVE KIDS PRESCHOOL
FACILITY NUMBER: 364841303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited

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101212(d)(1)(C) Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence.
This requirement was not met as evidenced:
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Licensee failed to report a that Child #1 exposed his/her private area to children in the classroom. The incident was not reported to licensing within the required time limit of 24 hours via phone and seven days in writing. This poses a potential risk to the Health and Safety of the children in care.
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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: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
LIC809 (FAS) - (06/04)
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