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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360908323
Report Date: 12/16/2024
Date Signed: 12/16/2024 03:00:34 PM

Document Has Been Signed on 12/16/2024 03:00 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:OCS RESURRECTION ACADEMYFACILITY NUMBER:
360908323
ADMINISTRATOR/
DIRECTOR:		TOMMIE MACIELFACILITY TYPE:
850
ADDRESS:17434 MILLER AVENUETELEPHONE:
9098224431
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 45TOTAL ENROLLED CHILDREN: 22CENSUS: 17DATE:
12/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Tommie Maciel, Director
Angelica Regalado, Principal 		TIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On December 16, 2024, Licensing Program Analysts (LPAs) Taityana Benson and Elyse Jones arrived at the facility for a separate matter. LPAs meet with Director, Tommie Maciel and Principal Angelica Regalado, conducted interviews and requested/obtained facility documentation.

It was discovered during the inspection, two staff did not have immunization records in their employee file. Lastly, the staff did not have their immunization records available for review electronically or by an additional method.

See LIC809-D for deficiency cited

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.

An exit interview was conducted, and report was reviewed with Director, Tommie Maciel and Principal Angelica Regalado.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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 12/16/2024 03:00 PM - It Cannot Be Edited


Created By: Taityana Benson On 12/16/2024 at 02:28 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: OCS RESURRECTION ACADEMY
FACILITY NUMBER: 360908323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
HSC
1596.7995(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.

This requirement is not met as evidenced by:
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Licensee agrees to have staff submit proof of their immunization record to include MMR influenza and pertussis. Licensee agrees to maintain proof in the facility file and submit proof of the Plan of Correction (POC) by the close of the business of 12/30/2024.
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Based on record review, the licensee did not comply with the section cited above as LPAs did not observe immunization records for two staff members and the two members could not provide a copy of their immunization records by an additional method during the visit.
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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:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


LIC809 (FAS) - (06/04)
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