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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843950
Report Date: 06/23/2022
Date Signed: 06/23/2022 05:22:27 PM

Document Has Been Signed on 06/23/2022 05:22 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:WILD ROOTS HOLISTIC LEARNING CENTERFACILITY NUMBER:
334843950
ADMINISTRATOR:TANYA GAETEFACILITY TYPE:
830
ADDRESS:27655 JEFFERSON AVENUETELEPHONE:
(951) 676-8300
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: 20TOTAL ENROLLED CHILDREN: 17CENSUS: 10DATE:
06/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Margarita JuarezTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) James Wilkerson & Jessica Rubio arrived at this facility to conduct a 1 Yr Annual visit for the preschool component for this site. During this visit it was discovered that Staff #1 (S1) has been working in the infant program for over five months without a criminal record clearance or exemption.

See LIC 809D for deficiency cited as per Title 22 Regulations.

A Civil Penalty has been assessed on this visit. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

See LIC 421BG for Civil Penalty assessed on this date.

An exit interview was conducted, appeal rights discussed and provided along with a copy of form LIC 9224 (AB 633) and a copy of this report to this facility on this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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 06/23/2022 05:22 PM - It Cannot Be Edited


Created By: James Wilkerson On 06/23/2022 at 03:38 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: WILD ROOTS HOLISTIC LEARNING CENTER
FACILITY NUMBER: 334843950

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/24/2022
Section Cited
CCR
101170(e)(1)

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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: (1) Obtain a California clearance or a criminal record exemption as required by the Department . This requirement was not met as evidenced
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Program Director, Maragarita Juarez agrees to have Staff #1 (S1) go to livescan for a fingerprint clearance by 06/24/22 and ensure that S1 does not work in the facility prior to the clearance.
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by: Staff #1 (S1) does not have a criminal record clearance or a criminal record exemption and has been working in the classroom for over five months.

This poses an immediate risk to the health and safety of the children.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:James Wilkerson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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