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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830481
Report Date: 02/01/2022
Date Signed: 02/01/2022 04:51:41 PM

Document Has Been Signed on 02/01/2022 04:51 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:CHILDRENS LIGHTHOUSE OF RIVERSIDE, CAFACILITY NUMBER:
334830481
ADMINISTRATOR:JANICE WILSONFACILITY TYPE:
850
ADDRESS:19743 LURIN AVENUETELEPHONE:
(951) 653-6688
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 128TOTAL ENROLLED CHILDREN: 128CENSUS: 42DATE:
02/01/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Bonnie Acosta and Abree FuentesTIME COMPLETED:
04:50 PM
NARRATIVE
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On 02/01/2022 a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido due to deficiencies found during the course of another inspection.

1) Reporting Requirements: Facility did not report to Community Care Licensing COVID incidents for children and staff by telephone or fax to the department by the next business day (24 hours).

2)101223(a)(2) Personal Rights Facility is not implementing current CDPH guidance for face covering in the preschool program.

SEE LIC 809-D for the deficiencies cited.


The Director was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the Director; and the LPA observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2022
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 02/01/2022 04:51 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 02/01/2022 at 03:54 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: CHILDRENS LIGHTHOUSE OF RIVERSIDE, CA
FACILITY NUMBER: 334830481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2022
Section Cited
CCR
102212(d)

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101212(d) Reporting requirements-(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and …. This requirement is not met as evidenced by:
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Facility Director and Owner will submit individual statement of understanding for Reporting requirements and how they will comply with reporting to CDSS and CDPH.

* LPA provided copy of reporting requirements to facility Director and discussed Unusual Incident Report LIC624
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Based on staff interviews conducted and management admission facility failed to report COVID incidents as required. This poses a potential health and safety risk to children in care.
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Facility will also submit letter for COVID exposure for children and submit to LPA Carbullido by POC due date of 02/04f/2022
Type B
02/04/2022
Section Cited
CCR101223(a)(2)

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101223(a)(2) Personal Rights
2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as eveidenced by:
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Facility will post additional signs at facility for mask wearing and implement CDPH face mask guidance including email notification to parents. Facility will send pictures of additional signs, letter to parents to LPA Carbullido at giselle.carbullido@dss.ca.gov.
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Based on LPA observation and staff interviews, the facility is not following COVID-19 best practices for face covoernings by children or staff. This poses a potential health and safety risk for children in care.
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Facility will hold a staff meeting to review CDPH guidance for child care and face coverings and submit staff attendance list to the Department. Facility will complete these items by POC due date of 02/04/2022.
* LPA provided copies of current CDPH guidance to facility Director and Owner.
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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2022


LIC809 (FAS) - (06/04)
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