334846163-1-2-2024-09-CC-EJOS-CZ4PPF-20240102102928

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846163
Report Date: 01/02/2024
Date Signed: 01/02/2024 10:29:32 AM

Document Has Been Signed on 01/02/2024 10:29 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KIDDIE ACADEMY OF CORONA		FACILITY NUMBER:	334846163
ADMINISTRATOR:	MELISSA BORBOA		FACILITY TYPE:	830
ADDRESS:	3977 BEDFORD CANYON RD		TELEPHONE:	(951) 444-7434
CITY:	CORONA	STATE: CA	ZIP CODE:	92883
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 8	DATE:	01/02/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	07:48 AM
MET WITH:	Melissa Burboa, Director		TIME COMPLETED:	10:45 AM

NARRATIVE

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A Case Management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. It was noted on December 11, 2023 a Staff member redirected a child in a forceful manner which caused the child to roll on the carpet. The Director and Licensee spoke with the Authorized Representatives of the child and interviewed Staff present. Facility is currently working on an action plan to ensure all children's health, safety and well being is priority.

During the tour of the facility the LPA observed where the child rolled on the carpet. Records were reviewed and interviews were conducted. All pertinent parties were not available for interviews. Based on information gathered, the facility acted appropriately and no violations have been identified. The Director contacted Authorized Representatives, conducted an internal investigation and reported the incident to Licensing according to the Title 22 regulations.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director, Melissa Burboa.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

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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