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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846609
Report Date: 08/27/2025
Date Signed: 08/27/2025 06:22:19 PM

Document Has Been Signed on 08/27/2025 06:22 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MELODY LANE CHILDREN'S CENTERFACILITY NUMBER:
334846609
ADMINISTRATOR/
DIRECTOR:		M.D. SOCORRO CAMACHO AYALAFACILITY TYPE:
860
ADDRESS:9191 COLORADO AVENUETELEPHONE:
(714) 944-9959
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 93TOTAL ENROLLED CHILDREN: 93CENSUS: 25DATE:
08/27/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Maria Socorro Camacho AyalaTIME VISIT/
INSPECTION COMPLETED:
06:35 PM
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On 08/27/2025 at 1:20 PM, Licensing Program Analysts (LPAs), Susan Brewer and Diana Brasel, arrived at the facility at the request of the Licensee Director Maria Socorro Camacho Ayala and Licensee Delma Portillo, for the purpose of conducting a Case Management Visit for Increase of Capacity of the School Age Program and a Decrease of the Preschool Program. In addition, the licensees are requesting to make a room change. The licensees have made a change to the original requested capacity, the original LIC 200A was corrected to reflect the changes and an original updated LIC 200A was obtained at time of visit. As of today, the licensees have requested 14 infants ages 6 weeks - 24 months in room 3, room 2 is the napping room only, 49 preschool children ages 2-5 in room 1, 4, 10A and 10B, 30 school-age children 6-12 years of age in rooms 5 and 9A, with a facility total of 93. The current overall capacity is 93. LPA’s were greeted by the Licensee Director and granted entry to tour Preschool center, inside and out.

Days and Hours of operation: Monday - Friday 6:00 AM to 6:00 PM.

Present during today’s inspection were 4 infants with 2 staff, 10 preschool children 3 staff, 11 school-age children with 1 staff. Appropriate ratios and supervision were observed. All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Maria Socorro Camacho Ayala staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities.

LPA Brewer continued to tour the facility. All measurements for the rooms were taken on 11/12/24 during the Pre-licensing visit by LPA Brasel. Total indoor activity space measured for infants 622.08, preschool 1778.05, and school-age 1082.08, which is sufficient to accommodate the requested capacity of 14 infants, 49 preschool children, and 30 school-age children.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334846609
VISIT DATE: 08/27/2025
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LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via drinking fountains and children's water bottles. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property.

Fire clearance was granted on 08/13/2025.

LPA’s observed a total of 1 sink and 1 potty chair available for infant use, 5 sinks and 6 toilets 2 of which are urinals available for preschool children’s use, 2 sinks and 2 toilets available for school-age children’s use. These are sufficient to accommodate the requested capacity of 14 infants, 49 preschool children, and 30 school-age children.

The facility currently has 3 fully fenced playgrounds. Fencing for the preschool is chain link and wrought iron, fencing for the infant is wrought iron and chain link, fencing for the school-age is chain link. Shade is provided over the preschool playground via a large tree, licensee/director understands if the tree is removed or no longer provides shade additional shade shall be installed. Shade for the infant playground is shade tarp and trees. School-age has a large, slatted pergola shade structure. All fencing is at least four feet high. The total square footage for the outdoor activity space for infants is 1815.70, pre-school 6568.88, school-age 10000.00, which is sufficient to accommodate all 3 components requested capacity. (Outdoor measurements were taken during pre-licensing visit on 11/12/24 by LPA Brasel, no changes have been made to the outdoor playgrounds.) There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a large climbing structure on the school-age playground, which is age appropriate and properly anchored. The preschool playground has a small slide, two climbing structures. There is adequate cushioning material in fall zones on the school-age playground which is rubber mulch. The preschool playground has adequate cushioning material of rubber mulch and natural grass. The infant playground has natural grass.

Drinking water is available via children's personal water bottles using filtered water and disposable cups if needed. The children use their own water bottles and drinking fountains for outdoor use. LPA observed all hazardous items on the playground to be inaccessible to children.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334846609
VISIT DATE: 08/27/2025
NARRATIVE
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The Licensee/Director was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

A review of staff records on 08/27/2025 indicates that all facility staff or other individuals who require caregiver background checks have NOT received criminal record and child abuse index clearances or exemptions.

During today's inspection, LPA Susan Brewer, conducted a tour of the facility, lead by the licensees. The LPA observed a subject staff providing care and supervising infant children. The subject was not associated to the facility. Upon further review of personnel records, the licensee was unable to provide proof of a criminal record clearance for the subject staff.

No corrections are needed for the increase/decrease application request.
A correction is due for the deficiencies issued on today’s date for a Type A and Type B violations.

Once the corrections have been completed, the requested increase/decrease with an overall capacity of 93 children, 14 infants, 49 preschool, and 30 school-age children will be granted upon a final file review.

See LIC809D for cited deficiency for a Type A CCR 101170(e)(2) Criminal Record Clearance and Type B HSC 1596.7995 Immunization.

IF a Civil Penalty has been assessed during this inspection. 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.

LPAs Susan Brewer and Diana Brasel informed Licensee Director Maria Socorro Camacho Ayala and Licensee Delma Portillo that this report dated 08/27/2025 documents Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 08/27/2025 06:22 PM - It Cannot Be Edited


Created By: Susan Brewer On 08/27/2025 at 04:59 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: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334846609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2025
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 & Safety Code Section 1596.871... shall prior to working... Obtain a California clearance or a criminal record exemption as required by the Department
This regulation was not met as evidenced by:
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The licensee agrees to ensure Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health & Safety Code Section 1596.871... shall prior to working...Obtain a California clearance or a criminal record exemption as required by the Department
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Based on LPA S. Brewer's observation & record review, the licensee was unable to provide proof of association by criminal record clearance as of 06/02/25 for a subject staff supervising infant children on today's date, which is a potential risk to the health & safety of children in care.
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The licensee agrees to submit a statement of understanding the regulation for Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health & Safety Code Section 1596.871, and submit proof of the clearance for a subject staff by fax, mail or e-mail.

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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334846609
VISIT DATE: 08/27/2025
NARRATIVE
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Also, LPA Susan Brewer and Diana Brasel informed the Licensee Director Maria Socorro Camacho Ayala and Licensee Delma Portillo to provide a copy of this licensing report 08/27/2025 that documents any Type A citation(s) 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.

A Civil Penalty was issued on today’s date in the amount of $500.00.

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 was conducted and report was reviewed with Licensee Director Maria Socorro Camacho Ayala and Licensee Delma Portillo.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 08/27/2025 06:22 PM - It Cannot Be Edited


Created By: Susan Brewer On 08/27/2025 at 05:37 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: MELODY LANE CHILDREN'S CENTER
FACILITY NUMBER: 334846609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2025
Section Cited
HSC
1596.7995

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§1596.7995 Employees... at day care center; immunization requirements...(a) (1) Commencing 09/01/2016, a person shall not be employed or volunter...if he or she has not been immunized against influenza, pertussis, and measles...& shall receive an influenza vaccination between
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The licensee agrees to submit proof of Measles, Pertussis and Influenza immunizations or letter to decline the influenza vaccination for a subject staff by fax, mail or email to the department.
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Aug. 1 & Dec. 1 of each year.
This regulation was not met as evidenced by: The licensee was unable to provide proof of measles, Pertussis and/or influenza vaccinations for a subject staff which is a potential risk to the health & Safety of Children in care.
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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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2025


LIC809 (FAS) - (06/04)
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