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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844065
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:14:11 PM

Document Has Been Signed on 02/27/2024 12:14 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MENIFEE PRESCHOOL-QUAIL VALLEYFACILITY NUMBER:
334844065
ADMINISTRATOR:NISSAR, DR IFTHIKA "SHINE"FACILITY TYPE:
850
ADDRESS:23757 CANYON HEIGHTS DRIVETELEPHONE:
(951) 672-6478
CITY:QUAIL VALLEYSTATE: CAZIP CODE:
92587
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
02/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Christy MoranTIME COMPLETED:
12:25 PM
NARRATIVE
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On February 27, 2024, Licensing Program Analyst (LPA) Amber Shaw and Licensing Program Manager (LPM) Carlos Martinez conducted an unannounced case management visit in response to the receipt of an unusual incident report submitted to the department by the facility on 1/19/24. The UIR indicates the Child 1 (C1) was separated from her class and left unattended by an adult for 3.5 minutes. LPA met with director Christy Moran to gather additional details surrounding the incident. As per the interview, staff did a last check of the restroom which included an observation under each stall. It was determined that C1 had lifted her legs while using the toilet.

Based on the information gathered, facility staff did not meet the Responsibility for Providing Care and Supervision, therefore a deficiency has been cited. See the next page for deficiency cited.

The licensee understands that it must remain posted for the next 30 days along with a copy of all Type A deficiency (LIC809D) cited during this inspection. A copy(LIC 9224) of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of the child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months.

See LIC809-D for cited deficiencies.



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

An exit interview was conducted, and this report was reviewed with the Director Christy Moran. Appeal rights were discussed and provided during the exit interview.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 12:14 PM - It Cannot Be Edited


Created By: Amber Shaw On 02/27/2024 at 11:57 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-QUAIL VALLEY
FACILITY NUMBER: 334844065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision. No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Director will submit plan with details of new restroom procdures to LPA by POC due date
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Staff left one child in the restroom alone.
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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:Amber Shaw
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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