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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818374
Report Date: 07/03/2023
Date Signed: 07/03/2023 04:26:38 PM

Document Has Been Signed on 07/03/2023 04:26 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:INLAND VINEYARD PRESCHOOLFACILITY NUMBER:
334818374
ADMINISTRATOR:ANGELA TWYMANFACILITY TYPE:
850
ADDRESS:935 N. MCKINLEYTELEPHONE:
(951) 549-8396
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 133TOTAL ENROLLED CHILDREN: 133CENSUS: 11DATE:
07/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Angela Twyman, DirectorTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analysts(LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to conduct a Case Management-Deficiencies inspection for the purpose of addressing separate matters that were discovered during an inspection at the facility. During the inspection LPAs observed S1 providing Supervision & Care. S1's Criminal Record Clearance is not associated to the facility or any other facility owned by the Licensee.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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 07/03/2023 04:26 PM - It Cannot Be Edited


Created By: Elyse Jones On 07/03/2023 at 04:00 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: INLAND VINEYARD PRESCHOOL
FACILITY NUMBER: 334818374

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2023
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
(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).
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have a Criminial Record Clearance associated to the facility. Director stated an email was sent to the Department requesting association, however, the email was unable to be located by the Director.
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This requirement was not evidenced by:
Based on record review, the Licensee did not meet Criminal Record Clearance which poses an immediate Health, Safety & Personal Rights risk to the children in care. During the inspection LPAs observed S1 providing Supervision & Care and did not
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Director agrees to send required documents to the Department to have S1 associated and understands S1 cannot work until S1 is associated.

Civil Penalty assessed. $100 per day for 5 days.

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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 Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023


LIC809 (FAS) - (06/04)
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