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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819429
Report Date: 08/30/2024
Date Signed: 08/30/2024 11:08:03 AM

Document Has Been Signed on 08/30/2024 11:08 AM - 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/
DIRECTOR:		DR. IFTHIKA "SHINE" NISSARFACILITY TYPE:
850
ADDRESS:26350 LA PIEDRA ROADTELEPHONE:
(951) 672-6478
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 170TOTAL ENROLLED CHILDREN: 170CENSUS: 0DATE:
08/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Christy MoranTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On August 30, at 09:35 AM Licensing Program Analyst (LPA) Courtnee Peebles arrived at the facility to conduct a case management visit in response on unusual incident report (UIR) from the facility. The UIR regarding C1 being left unattended while using the restroom, was received by the licensing agency on 05/30/2024. LPA met with Director Christy Moran.

The Department was made aware of an incident of S1 leaving children unattended in the preschool restroom while S1 other students transitioned to the playground. LPA informed Christy Moran that the CCC must provide appropriate supervisor to day care children at all times and all unusual incidents must be reported to the department within 24 hours through the Duty line and a written report must be submitted within 7 days.

The facility is being cited for Title 22 Regulation Section 101229 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 shall include visual observation.

An exit interview was conducted, and a copy of this report was provided to Director Christy Moran

A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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 08/30/2024 11:08 AM - It Cannot Be Edited


Created By: Courtnee Peebles On 08/30/2024 at 10:49 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: MENIFEE PRESCHOOL
FACILITY NUMBER: 334819429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
HSC
101229(a)(1)

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101229 (a) (1) Responsibility for Providing Care and Supervision.
The licensee shall provide care and supervision as necessary to meet the children's needs...Supervision shall include visual observation.
This evidence was not met as evidence by...
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Director stated, they have completed supervision training for all staff, going over how to properly do names to faces and ensuring all children are present during transitioning.
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Based on confidential interviews,S1 failed to meet supervision requirements, resulting in leaving C1 unatteneded in the restroom for two 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Courtnee Peebles
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024


LIC809 (FAS) - (06/04)
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