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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846163
Report Date: 09/15/2023
Date Signed: 09/27/2023 12:25:02 PM

Document Has Been Signed on 09/27/2023 12:25 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:
334846163
ADMINISTRATOR:MELISSA BORBOAFACILITY TYPE:
830
ADDRESS:3977 BEDFORD CANYON RDTELEPHONE:
(951) 444-7434
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 20DATE:
09/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee Nemi Kotadiya & Director Melissa BorboaTIME COMPLETED:
02:30 PM
NARRATIVE
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***Deficiency cited on 9/15/2023 is being amended to remove the citation re: Teacher to Child Ratio*****
On 09/15/2023 Licensing Program Analysts (LPAs) Raymond Moorehead, Claudia Caywood, and Licensing Program Manager (LPM) Aaron Ross were at the facility on separate matters. The following was revealed.

On 08/07/2023, the facility was found to be operating out of ratio which is a violation of Title 22 Regulations Section 101416.5(b) Staff-Infant Ratio. LPAs and LPM obtained sign in/sign out sheets for children and time sheets for staff from the facility. According to the obtained documentation, LPAs and LPM discovered that the facility was operating out ratio with 1 infant teacher providing care and supervision to 8 infants in the morning, prior to 7:58 AM. LPAs and LPM informed the Licensee and Director that the Staff-Infant Ratio is 1 teacher to 4 infants. See LIC 809-D for cited deficiency.

LPA instructed the licensee and director to provide a copy of this licensing report dated 09/15/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with the Director, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site Visit (LIC 9213) was issued. The Notice of Site Visit shall be posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report must be made available for the next three years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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 09/27/2023 12:25 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/18/2023 04:13 PM


Created By: Raymond Moorehead On 09/15/2023 at 11:06 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KIDDIE ACADEMY OF CORONA
FACILITY NUMBER: 334846163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2023
Section Cited
CCR
101416.5(b)

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****Deficiency cited on 9/15/2023 is being amended to remove the citation regarding Teacher to Child Ratio*****
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****Deficiency cited on 9/15/2023 is being amended to remove the citation regarding Teacher to Child Ratio*****

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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:Aaron Ross
LICENSING EVALUATOR NAME:Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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