<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846161
Report Date: 08/16/2023
Date Signed: 08/16/2023 05:07:14 PM

Document Has Been Signed on 08/16/2023 05:07 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KIDDIE ACADEMY OF CORONAFACILITY NUMBER:
334846161
ADMINISTRATOR:MELISSA BORBOAFACILITY TYPE:
850
ADDRESS:3977 BEDFORD CANYON RDTELEPHONE:
(951) 444-7434
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 42DATE:
08/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Nemi Kotadiya, Licensee Melissa Borboa, DirectorTIME COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/16/2023 at 09:05 AM, Licensing Program Analysts (LPA) Claudia Caywood and Licensing Program Manager Aaron Ross arrived at the facility to conduct a Case Management Deficiencies. Upon arrival, LPA was met by Licensee, Nemi Kotadiya and Director Melissa Borboa. LPA stated to the licensee and director the purpose of the visit. During the facility check, LPA toured the facility (inside and outside), and took a census. The following staff members were observed providing care and supervision without fingerprint association:

1) Teacher #1 has a fingerprint clearance but is not associated to the facility. They were hired on 8/08/2023.

2) Teacher #2 has a fingerprint clearance but is not associated to the facility. They were hired on 7/26/2023

3) Teacher #3 has a fingerprint clearance but is not associated to the facility. They were hired on 8/08/2023

4) Teacher #4 has a fingerprint clearance but is not associated to the facility. They were hired on 2/21/2023

5) Teacher #5 has a fingerprint clearance but is not associated to the facility. They were hired on 8/08/2023

LPA informed the facility licensee and director that according to Title 22 Regulations all individuals who work or volunteer must be fingerprint cleared and associated to the facility prior to being employed.

Deficiencies cited. (See 809-D)

An exit interview was conducted, and report was reviewed with the licensee, Nemi Kotadiya and Director Melissa Borboa. A Notice of Site Visit was issued and is to be posted in a prominent location at the facility for the next 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/16/2023 05:07 PM - It Cannot Be Edited


Created By: Claudia Caywood On 08/16/2023 at 04:15 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: KIDDIE ACADEMY OF CORONA
FACILITY NUMBER: 334846161

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/17/2023
Section Cited
CCR
101170(f)

1
2
3
4
5
6
7
CRIMINAL RECORD CLEARANCES: A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from TrustLine to a state licensed facility by providing the following documents to the Department:
1
2
3
4
5
6
7
Licensee/Director agrees to submit proof of criminal record association to the department by 8/17/2023
8
9
10
11
12
13
14
This evidence was not met by: While touring the facility, LPA observed 5 teacher's providing care and supervision to children in care without being associated to the facility. This citation results in a civil penalty in the amount of $2500
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2