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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846209
Report Date: 09/01/2022
Date Signed: 09/01/2022 06:22:27 PM


Document Has Been Signed on 09/01/2022 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:FERN ACADEMY EDUCATIONAL CHILDCAREFACILITY NUMBER:
364846209
ADMINISTRATOR:HE, LINGLINFACILITY TYPE:
850
ADDRESS:6921 SCHAEFER AVETELEPHONE:
(909) 696-9638
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:128CENSUS: 64DATE:
09/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Licensee Linglin He and Director April AguilarTIME COMPLETED:
06:45 PM
NARRATIVE
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On 9/1/2022, Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to address a separate and unrelated issue. However, in conducting a tour, taking and census, and verifying staff association to the facility, one staff was not listed under the facility associations. After reviewing the staff file and additional facility files, it was verified that the staff was never associated to the facility. It was also verified that the staff has been working at the facility for over five days.

The non-association of the staff constitutes a violation of Title 22 regulations regarding the requirement of Criminal Record Clearances and Transfers.

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.

See LIC809-D for cited deficiency

LPA Samuel Lopez informed Licensee Linglin He and Director April Aguilar that this report dated 9/1/2022 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) 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.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209
VISIT DATE: 09/01/2022
NARRATIVE
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Also, LPA Samuel Lopez informed the Licensee Linglin He and Director April Aguilar to provide a copy of this licensing report dated (9/1/2022) 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.

Exit interview conducted and report was reviewed with the Licensee Linglin He and Director April Aguilar.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2022 06:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: FERN ACADEMY EDUCATIONAL CHILDCARE
FACILITY NUMBER: 364846209

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2022
Section Cited

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Personnel Requirement - Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not being met as evidenced by the observation made by the LPA that staff Kathia Gonzales was providing care and supervision to children in care however,
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staff was/is not associated to the facility. This poses an immediate risk to the health, safety, and personal rights of the children in care.
This citation comes with a $500.00 civil penalty, which will be issued today
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Statement to be submitted to the Riverside Child Care Regional Office by 9/2/2022.

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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 RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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