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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334806776
Report Date: 11/18/2022
Date Signed: 11/18/2022 02:45:18 PM

Document Has Been Signed on 11/18/2022 02:45 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MURRIETA VALLEY USD/CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334806776
ADMINISTRATOR:KATHLEEN ISRAELSENFACILITY TYPE:
850
ADDRESS:24300 LAS BRISAS ROADTELEPHONE:
(951) 696-2183
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 132TOTAL ENROLLED CHILDREN: 93CENSUS: 11DATE:
11/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Kathleen IsraelsenTIME COMPLETED:
08:45 AM
NARRATIVE
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A case management visit is being conducted by Licensing Program Analyst (LPA) James Wilkerson in response to the receipt of a self-reported unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 11/11/22. It indicates that on 11/10/22, a child was left unattended inside a classroom while staff transitioned the other children to the playground. The lone child was found inside the classroom by a parent. The parent while taking the child to the playground met up with the staff from the classroom and the other children who were on the way back to the classroom upon discovering that a child had been left inside the classroom. Staff indicate that the incident took less than three minutes.

Based on the information gathered, the following violations have been identified: Responsibility for Providing Care and Supervision.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

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.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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: MURRIETA VALLEY USD/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 334806776
VISIT DATE: 11/18/2022
NARRATIVE
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The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days.

An exit interview was conducted, appeal rights discussed, and a copy of this report will be provided to facility staff.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2022 02:45 PM - It Cannot Be Edited


Created By: James Wilkerson On 11/18/2022 at 08:04 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MURRIETA VALLEY USD/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 334806776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision - (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision
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Director, Kathleen Israelsen submitted an email to CCL explaining that there was a program wide training on expectations and best practices on supervision protocols.
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shall include visual observation. This requirement was not met as evidenced by: A child was left unattended inside a classroom while staff was transitioning the other children to the playground. The child was found alone inside the classroom by a parent. Staff discovered the mistake and was on the way to get the child who was left alone for approximately three minutes.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:James Wilkerson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022


LIC809 (FAS) - (06/04)
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