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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330900318
Report Date: 02/07/2025
Date Signed: 02/07/2025 10:37:51 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/16/2025 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250116105215
FACILITY NAME:FIRST CHRISTIAN CHURCH PRESCHOOLFACILITY NUMBER:
330900318
ADMINISTRATOR:ELIZABETH MARTINEZFACILITY TYPE:
850
ADDRESS:4055 JURUPA AVENUETELEPHONE:
(951) 683-5780
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:50CENSUS: 16DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Carol Silva/ Elizabeth MartinezTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility did not provide complaint report timely to authorized representatives.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido conducted a subsequent complaint investigation to deliver final findings. An initial visit was conducted on 01/17/2025, at which time LPA conducted interviews and reviewed records. LPA met with facility representatives, Elizabeth Martinez and Carol Silva; toured facility, and took a census.
During the investigation, LPA interviewed all pertinent parties, including facility staff, and reviewed records.
It was alleged facility did not provide a complaint report, in which a Type A citation was issued, timely to the authorized representative. Pertinent party interviews acknowledged not providing a copy of the complaint report, dated 12/19/24, in a timely manner, with some authorized representatives not receiving notification until January of 2025.
LPA reviewed a sampling of children attendance sheets and Acknowledgment of Receipt forms (LIC 9224). Documents showed signature of receipts for the complaint report a few days to a month after children were in attendance.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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 09-CC-20250116105215
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FIRST CHRISTIAN CHURCH PRESCHOOL
FACILITY NUMBER: 330900318
VISIT DATE: 02/07/2025
NARRATIVE
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Based on information gathered from interviews and records, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Health and Safety Code1596.8595(c)(1) is being cited on the attached LIC9099D.
Appeal rights issued and discussed with facility representative and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted and a copy of this report and notice of site visit were provided to facility representatives Elizabeth Martinez and Carol Silva. A copy of this report must be made available to the public upon request for three years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/16/2025 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250116105215

FACILITY NAME:FIRST CHRISTIAN CHURCH PRESCHOOLFACILITY NUMBER:
330900318
ADMINISTRATOR:ELIZABETH MARTINEZFACILITY TYPE:
850
ADDRESS:4055 JURUPA AVENUETELEPHONE:
(951) 683-5780
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:50CENSUS: 16DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Carol SilvaTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff handled day care child in an inappropriate manner.
Staff yelled at day care child.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido conducted a subsequent complaint investigation to deliver final findings. An initial visit was conducted on 01/17/2025, at which time LPA conducted interviews and reviewed records. LPA met with facility representatives, Elizabeth Martinez and Carol Silva; toured facility, and took a census.
It was alleged staff yelled and held a child’s arm up high in the p.m. consolidation classroom. Pertinent party interviews acknowledged holding a child by the wrist/hand for supervision when child cried at departure of their regular teacher. Additionally, interviews reported not being present or denied observing anyone yelling or mishandling a child in an inappropriate manner.
Due to conflicting information obtained from what was alleged, the evidence collected was not sufficient to substantiate or refute the above allegation. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20250116105215
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FIRST CHRISTIAN CHURCH PRESCHOOL
FACILITY NUMBER: 330900318
VISIT DATE: 02/07/2025
NARRATIVE
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An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the facility representative.
LPA observed the Notice of Site Visit was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 09-CC-20250116105215
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FIRST CHRISTIAN CHURCH PRESCHOOL
FACILITY NUMBER: 330900318
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2025
Section Cited
HSC
1596.8595(c)(1)
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HSC:1596.8595(c)(1): A licensed child day care facility shall provide to the parents ... copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care .... This requirement is not met as evidenced by:
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Facility will submit proof of receipt for licensing report dated 12/19/24 to the department by POC due date 02/14/2025.
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Based on LPA’s record review and interviews conducted the facility did not comply with the section cited above in providing a licensing report timely from visit conducted on 12/19/24 to authorized representatives This is a potential risk to the health and safety of 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.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5