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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846079
Report Date: 02/19/2025
Date Signed: 02/19/2025 04:52:37 PM

Document Has Been Signed on 02/19/2025 04:52 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:FORTUNE PRESCHOOLFACILITY NUMBER:
364846079
ADMINISTRATOR/
DIRECTOR:		SAHLAH STORKSFACILITY TYPE:
850
ADDRESS:655 W 2ND STTELEPHONE:
(909) 884-1410
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY: 36TOTAL ENROLLED CHILDREN: 13CENSUS: 8DATE:
02/19/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Sahlah Storks, Preschool DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On the date and time listed, Licensing Program Analyst (LPA) Taityana Benson arrived at the facility to conduct an inspection regarding a separate matter. Upon arrival at the facility, LPA Benson was greeted by Preschool Director Sahlah Storks. An uncleared staff member (S1) was observed by LPA Benson at the time of the visit, during the physical inspection of the facility. The uncleared staff member (S1) was observed engaging with the day care children. It was disclosed that the uncleared staff member has been employed at the facility since November 2024.

Based on observation, this is a violation of Title 22 regulation 101170(e)(1) Criminal Record Clearance.

See LIC9099-D for deficiency cited per California Code of Regulations Title 22, Division 12.


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.

LPA Taityana Benson informed Preschool Director Sahlah Storks, that this report dated 02/19/2025 documents a 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.

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.

Report Continued On LIC809-C

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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Document Has Been Signed on 02/19/2025 04:52 PM - It Cannot Be Edited


Created By: Taityana Benson On 02/19/2025 at 03:37 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: FORTUNE PRESCHOOL
FACILITY NUMBER: 364846079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/20/2025
Section Cited
CCR
101170(e)(1)

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(e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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Licensee agrees that the uncleared staff member will not return to the facility until they have a criminal record clearance. Licensee agrees to provide proof of a completed LIC9163 for the uncleared staff member to LPA by 02/20/2025 via email.
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Based on observation, record review and interviews the facility did not comply with the section cited above as LPA observed one staff member present engaging with the day care children and whom were not associated to the facility, which poses an immediate health and safety risk to persons in care.
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A civil penalty of $100.00 per day is assessed, totalling for $500.00.

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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: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


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: FORTUNE PRESCHOOL
FACILITY NUMBER: 364846079
VISIT DATE: 02/19/2025
NARRATIVE
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Also, LPA Taityana Benson informed the Preschool Director Sahlah Storks, to provide a copy of this licensing report dated 02/19/2025 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, and report was reviewed with Preschool Director Sahlah Storksl.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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