<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812641
Report Date: 07/30/2024
Date Signed: 07/30/2024 01:56:51 PM

Document Has Been Signed on 07/30/2024 01:56 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MAGNOLIA PRESCHOOL & KINDERGARTENFACILITY NUMBER:
334812641
ADMINISTRATOR/
DIRECTOR:		RUTH GUTIERREZFACILITY TYPE:
840
ADDRESS:13130 MAGNOLIA AVENUETELEPHONE:
(951) 272-0977
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 8DATE:
07/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Alicia Flores, Area CoordinatorTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct a Case Management inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the facility tour the LPA observed S1 providing Supervision and Care to eight school age children without any other staff present. A file review was conducted for S1 which determined S1 is not a qualified teacher and does not have required documents. It was also determined S1 was not associated to the facility. Title 22 states, "As an alternative educational prerequisite, a school-age child care teacher may, pursuant to Health and Safety Code Section 1597.21, substitute 20 training hours for each of the required units of education in Section 101216.1. Units and training hours may be combined to meet the total educational requirement (12 units or 240 training hours, or any combination thereof)." Title 22 also states, "(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or"

See LIC 809-D for deficiency cited

LPA informed Alicia Flores that this report dated 7-30-2024 documents two Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the Health, Safety, or Personal Rights of children in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) was provided to facility during this inspection.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812641
VISIT DATE: 07/30/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The LIC 9224/Type A citation must be provided to parents/guardian of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for the verification.

Exit interview conducted and report was reviewed with Alicia Flores, Area Coordinator.

A Notice of Site Visit was given and must remain posted on, or immediately adjacent to the interior of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/30/2024 01:56 PM - It Cannot Be Edited


Created By: Elyse Jones On 07/30/2024 at 12:32 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2024
Section Cited
CCR
101170(e)(2)

1
2
3
4
5
6
7
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
1
2
3
4
5
6
7
facility.
Report will be forwarded to the Licensee. Licensee understands all individuals working, residing or volunteering at the facility must obtain a Criminal Record Clearance and be associated to the facility prior to working. Licensee shall submit a letter of understanding
8
9
10
11
12
13
14
Based on the record review, the Licensee did not meet the above regulation which poses an immediate an Safety risk to the children in care. During the facility tour LPA observed S1 providing Supervision and Care to eight school age children. After file review it was determined S1 was not associated to the
8
9
10
11
12
13
14
Letter and required documents to associate S1 must be submitted by close of business on 7-31-2024.

$500 Civil Penalty assessed
Type A
07/31/2024
Section Cited
CCR101516.2(b)

1
2
3
4
5
6
7
As an alternative educational prerequisite, a school-age child care teacher may, pursuant to Health and Safety Code Section 1597.21, substitute 20 training hours for each of the required units of education in Section 101216.1. Units and training hours may be combined to meet the total educational
1
2
3
4
5
6
7
S1 providing Supervision and Care to eight school age children. After file review and interview it was determined S1 was not hired to be teaching staff and is acting as an AM Teacher due to call offs. There is no documentation showing S1 meets the educational or training hour requirements.
8
9
10
11
12
13
14
requirement (12 units or 240 training hours, or any combination thereof).

Based on the record review, the Licensee did not meet the above regulation which poses an immediate an Safety risk to the children in care. During the facility tour LPA observed
8
9
10
11
12
13
14
Licensee understands all teachers must meet the Teacher Qualifications. Licensee understands S1 does not meet the qualifications and cannot be used as a teacher. Licensee shall submit a letter of understanding and a plan to ensure classes are properly staffed by COB on 7-31-24.
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 Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/30/2024 01:56 PM - It Cannot Be Edited


Created By: Elyse Jones On 07/30/2024 at 01:11 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MAGNOLIA PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 334812641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2024
Section Cited
HSC
1596.8662(b)(1)

1
2
3
4
5
6
7
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3)... And shall complete renewal manadated
1
2
3
4
5
6
7
Report will be forwarded to Licensee. Licensee agrees to have S1 complete Mandated Reporter training and submit certificate to the Department on or by POC due date of 8-15-2024.
8
9
10
11
12
13
14
reporter training every two years following the date on which he or she completed the initial mandated reporter training.
Based on the record review, the Licensee did not meet the above regulation which poses a potential safety risk to the children in care. During the file review for S1 the LPA was
8
9
10
11
12
13
14
Type B
08/15/2024
Section Cited
HSC1596.7995(a)(1)

1
2
3
4
5
6
7
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
1
2
3
4
5
6
7
Report will be forwarded to Licensee. Licensee agrees to obtain proof of immunizations and submit to the Department on or by POC due date of 8-15-2024.
8
9
10
11
12
13
14
Based on the record review, the Licensee did not meet the above regulation which poses a potential safety risk to the children in care. During the file review for S1 the LPA was unable to review immunizations for S1.
8
9
10
11
12
13
14
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 Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4