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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300089
Report Date: 12/11/2025
Date Signed: 12/11/2025 03:12:46 PM

Document Has Been Signed on 12/11/2025 03:12 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ABC CHILD CARE CENTERFACILITY NUMBER:
336300089
ADMINISTRATOR/
DIRECTOR:		ANGEL ANTONFACILITY TYPE:
830
ADDRESS:29705 SOLANA WAYTELEPHONE:
(951) 491-0940
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 50TOTAL ENROLLED CHILDREN: 47CENSUS: 37DATE:
12/11/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Mari Rivera, Facility RepresentativeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst’s (LPA’s) Courtnee Peebles and William Chancellor conducted an unannounced annual inspection on 12/11/2025 at 09:30 AM. LPA met with Facility Representatives, Mari Rivera and Shannon Mouser, who provided a tour of the center. This is a combination childcare center, and the following licensed programs were also inspected on this date: Preschool program, School age program and Mildly ill program. A tour of both the indoor and outdoor areas of the facility was conducted, and the following observations were noted.

The required postings, including the state the postings that were posted facility license, Emergency Disaster Plan (LIC610), Earthquake Preparedness Checklist (LIC9148), Parent’s Rights Poster (PUB393), Personal Rights (LIC613A), Child Car Seat Law, and menus, were observed to be up to date and appropriately displayed. The facility is operating within the capacity limits as stated on its license.

During the inspection, staff-to-child ratios were observed; ten (10) staff to thirty seven (37) infants. Classrooms contained age and size-appropriate furniture and equipment, free of hazards. Mari Rivera and Shannon Mouser, facility representatives confirmed that no weapons are present on the premises, and there are no accessible bodies of water. Mari Rivera and Shannon Mouser, facility representatives confirmed and is aware that any wading pools or similar items must be emptied immediately after use and stored upright. Drinking water is available both indoors and outdoors, with filtered water that is used to refill reusable water bottles.

Medications are stored in an area that is inaccessible to children, with the specific location noted. Hazardous items, including disinfectants, cleaning solutions, and other dangerous substances, are stored out of

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2025
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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Document Has Been Signed on 12/11/2025 03:12 PM - It Cannot Be Edited


Created By: Courtnee Peebles On 12/11/2025 at 01:21 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ABC CHILD CARE CENTER
FACILITY NUMBER: 336300089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above C1's medication was not labeled which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2025
Plan of Correction
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At the time of the visit staff were able to provide the department with documentation showing the medication belongs to C1. No further corrections needed at this time
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Pauline Beschorner
NAME OF LICENSING PROGRAM MANAGER:
Courtnee Peebles
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2025


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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ABC CHILD CARE CENTER
FACILITY NUMBER: 336300089
VISIT DATE: 12/11/2025
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children’s reach, while poisons and toxins are securely locked away. The floors were observed to be clean, safe, and well-maintained. Highchairs and tables have broad-based legs, and trays that lock into place for additional safety. Changing tables are within arm’s reach of a sink, have a minimum one-inch thick padding, and feature raised sides of at least three inches covered in washable vinyl or plastic. Proper handwashing procedures were observed before and after diapering and feeding.

The bathrooms were found to be clean, safe, and in proper working conditions. At least one potty chair is available for every five potty-training infants. Outdoor play areas are equipped with age and size-appropriate equipment in good condition. The food preparation area is clean, free of litter and pests, and properly maintained. Filtered water is used for food preparation Food is stored correctly to prevent contamination. Waste containers have tight-fitting covers and are in good repair.

The sign-in/sign-out records were reviewed and found to be compliant with regulations. Disaster drills are conducted at least every six months, with the most recent drill occurring on 11/11/2025. A review of children’s and staff records confirmed that all required documents are complete. Staff qualifications meet licensing requirements, and at least one staff member has a valid Pediatric CPR/First Aid certification and was present, with certification expiration dates documented. The facility representative has completed Health and Safety Training. Background clearances for all required staff members have been verified, ensuring compliance with criminal record and child abuse index clearance requirements.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871 must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days, or if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ABC CHILD CARE CENTER
FACILITY NUMBER: 336300089
VISIT DATE: 12/11/2025
NARRATIVE
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For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP.

LPA referred the facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information).

Include the applicable scenario for the CCC, un-bolded, into the report:


· CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES, OR

LPA discussed safe sleep regulations with the facility representative and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource . LPA also informed the facility representative of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provided Incidental Medical Services – IMS. LPA reviewed medication storage of equipment/supplies and reviewed children’s, personnel, and administrative records. During the facility tour LPA's observed C1 to be missing a label on a medication present at the facility, which posed a potential health and safety risk to children in care. However At the time of the visit staff were able to provide the department with documentation showing the medication belongs to C1. No further corrections needed at this time. This poses a potential health and safety risk to children in care. A type B citation will be issued. For IMS information see PIN 22-02-CCP. The following information regarding ADA compliance was provided: US Department of Justice (USDOJ)

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ABC CHILD CARE CENTER
FACILITY NUMBER: 336300089
VISIT DATE: 12/11/2025
NARRATIVE
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toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY), and the link to publication: Commonly Asked Questions about Child Care Centers and the ADA" available at https://www.ada.gov/resources/child-care-centers/.

The director was informed about the MyChildCarePlan.org website, a consumer education resource that HELPS families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA reviewed reporting requirements with the director, emphasizing that any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven days in writing. The Duty Officer can be reached Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200, or reports may be emailed to UnusualIncidentReportsDO10@dss.ca.gov.

To improve the quality of inspections, and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The director was requested to update and submit the following documents within 30 days, if applicable:

· LIC 500 Personnel Report,


· LIC 610 Emergency & Disaster Plan,
· Parent Handbook/Program Curriculum/Admission Policies and Procedures/Fee Schedule (if updates have been made or if the file copy is older than two years),
· LIC 309 Administrative Organization (if updated within the past two years), and
· LIC 308 Designation of Administrative Responsibility (if updated within the past two years).

See LIC809-D for cited deficiencies, if applicable. If no deficiencies were observed, it was noted that the facility is in compliance at this time.

A Notice of Site Visit was provided and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ABC CHILD CARE CENTER
FACILITY NUMBER: 336300089
VISIT DATE: 12/11/2025
NARRATIVE
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An exit interview was conducted with the facility representatives, Mari Rivera and Shannon Mouser, and a copy of this report was reviewed. Appeal rights were discussed and provided during the exit interview with the facility representatives, Mari Rivera and Shannon Mouser.
NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: Courtnee Peebles
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC809 (FAS) - (06/04)
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