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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845155
Report Date: 08/23/2023
Date Signed: 08/23/2023 05:25:35 PM

Document Has Been Signed on 08/23/2023 05:25 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:TRUTH PRESCHOOL ACADEMYFACILITY NUMBER:
364845155
ADMINISTRATOR:KARINA TAYLORFACILITY TYPE:
850
ADDRESS:602 N. VIRGINIA AVENUETELEPHONE:
(909) 986-1873
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 23DATE:
08/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kristy Rowell, licensee Danielle Alcala, DirectorTIME COMPLETED:
06:00 PM
NARRATIVE
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On 08/23/2023, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility on a different matter. During record review request, the facility was unable to provide requested documentation.

Based on observation and licensee's own admission, there were no documents available to review by the Department. -SEE LIC809D.

An exit interview was conducted with Licensee, Kristy Rowell and director, Danielle Alcala and appeal rights were provided. A Notice of Site visit was issued, along with a copy of this report. This report shall be made available to the public for three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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 08/23/2023 05:25 PM - It Cannot Be Edited


Created By: Aman Sharma On 08/23/2023 at 04:33 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: TRUTH PRESCHOOL ACADEMY
FACILITY NUMBER: 364845155

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/01/2023
Section Cited
CCR
101217(b)

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Personnel records shall be maintained for all volunteers and shall contain the following: (1)A health statement as specified in Section 101216(g).
(2) Tuberculosis test documents as specified in Section 101216(g)(3).
(3) For volunteers that are required to be
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A written understanding of the cited regulations and signatures and dates from both, director and licensee.
Both director and licensee agree to submit POC by POC due date.
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fingerprinted pursuant to Section 101170:
(A)A signed statement regarding their criminal record history as required by Section 101170(d). (B)Documentation of either a criminal record clearance/a criminal record exemption as required by 101170(e).This requirement was not met as evidenced by:
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The center was unable to provide any documentation for a volunteer at the facility. This poses a potential health and safety risk to persons in care.
Request Denied
Type B
09/01/2023
Section Cited
CCR101217(e)

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(e) In all cases, personnel records shall document the hours actually worked. This requirement was not met as evidenced by: The center was unable to provide any documentation of hours volunteered at the center. This poses a potential health and safety risk to persons in care.
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A written understanding of the cited regulations and signatures and dates from both, director and licensee.
Both director and licensee agree to submit POC by POC due date.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Aman Sharma
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023


LIC809 (FAS) - (06/04)
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