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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819429
Report Date: 01/22/2024
Date Signed: 01/22/2024 02:53:17 PM

Document Has Been Signed on 01/22/2024 02:53 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MENIFEE PRESCHOOLFACILITY NUMBER:
334819429
ADMINISTRATOR:DR. IFTHIKA "SHINE" NISSARFACILITY TYPE:
850
ADDRESS:26350 LA PIEDRA ROADTELEPHONE:
(951) 672-6478
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 170TOTAL ENROLLED CHILDREN: 170CENSUS: 63DATE:
01/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Chrisity MoranTIME COMPLETED:
03:00 PM
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On January 22 2024 at 01:34 PM Licensing Program Analyst (LPA) Courtnee Peebles arrived unannounced to Menifee Preschool to conduct a case management was greeted and granted access to the facility by Director (DIR) Christy Moran. The purpose is for a case management visit is in response to a Unusual Incident Report (UIR) received by the Community Care Licensing (CCL) on 01/10/24.
Confidential interview's were conducted with DIR.

Based on information gathered, the facility acted appropriately and no violations have been identified. Parents were immediately notified and C1 received appropriate medical care in a timely order.

Based on interviews it was confirmed there were three staff supervising the children on the newly built playground when C1 had an accident and fell. C2 was able to verbalize to staff what was witnessed and how C1 slipped and fell while climbing the ladder on the playground. Two staff did not witnessed C1's fall due to assisting another child up the playground ramp and the third staff did not witness C1's fall due to placement. No hazards were observed on the playground where the incident occurred. Parents of C1 and the CCC created a care plan for C1 due to C1 being in remission from Leukemia, C1 is easily fatigued and will attempt to keep going, she becomes increasingly unsteady and less coordinated.

There are no deficiencies at this time.

An exit interview was conducted, and a copy of this report was provided to facility staff.

Notice of site visit must be posted for 30 consecutive days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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