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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334816836
Report Date: 12/19/2024
Date Signed: 12/19/2024 04:16:03 PM

Document Has Been Signed on 12/19/2024 04:16 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CITY OF MORENO VALLEY CREEKSIDEFACILITY NUMBER:
334816836
ADMINISTRATOR/
DIRECTOR:		IRIS HUGHESFACILITY TYPE:
840
ADDRESS:13563 HEACOCK ST.TELEPHONE:
(951) 413-3286
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 20DATE:
12/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Iris Hughes, Site Supervisor TIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On December 19, 2024, at 02:00 PM, Licensing Program Analyst (LPA), Jesse Gardner, conducted an annual inspection as part of a compliance review. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:

During the annual inspection, and concluding a review of staff records on 12/19/2024, LPA found that staff or other individuals who require caregiver background checks have not received a cleared criminal record check. Staff One (S1) was found to not have a cleared background; thus, a $500 immediate civil penalty was issued. Record review further revealed that S1 had been working at the facility since 2023. LPA witnessed S1 leave the facility and S2 replace S1 to maintain ratio.

An exit interview was conducted where a copy of this report was reviewed with and provided to Site Supervisor Iris Hughes along with a copies of the LIC 421BG, LIC 811 (Confidential names list), LIC 809D (deficiency page), and Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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Document Has Been Signed on 12/19/2024 04:16 PM - It Cannot Be Edited


Created By: Jesse Gardner On 12/19/2024 at 03:37 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CITY OF MORENO VALLEY CREEKSIDE
FACILITY NUMBER: 334816836

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2024
Section Cited
CCR
101216(i)(1)

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Personnel Requirements: (i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations. These requirements were not being met as evidenced by:
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Licensee states they will immediately send S1 to get re-fingerprinted and provide proof of the clearance to LPA when received. Additionally, Licensee states they will provide an statement of understanding of the regulation to LPA by POC date
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Based on record review, S1 does not have a cleared background. This is an immediate health and safety risk to 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:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2024


LIC809 (FAS) - (06/04)
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