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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846577
Report Date: 08/20/2026
Date Signed: 08/20/2026 10:39:54 AM

Document Has Been Signed on 08/20/2026 10:39 AM - 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:SBCUSD-HIGHLAND-PACIFIC PRESCHOOLFACILITY NUMBER:
364846577
ADMINISTRATOR/
DIRECTOR:		KELLY, LATASHIAFACILITY TYPE:
860
ADDRESS:3340 PACIFIC STTELEPHONE:
(909) 880-6706
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 69TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
08/20/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kelly Fruchey - Permit TeacherTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On date and time listed above, Licensing Program Analyst (LPA) Justin Giese conducted an unannounced visit related to the submission of an Unusual Incident Report (UIR). The UIR was received by the licensing agency on 08/19/2026, pertaining to a child injury that occurred on 08/18/2026. LPA was granted entrance into the facility and met with Permit Teacher, Kelly Fruchey . The following was discussed:

The UIR received by the licensing agency documented a day care child sustained a fall injury to their head on 08/18/2026, while in care at the facility. Facility records were reviewed, documentation was obtained, and interviews were conducted with pertinent parties. It was disclosed that on 08/18/2026 a day care child sustained a bump/bruise to their forehead from a fall. It was revealed that a staff member witnessed the child fall due to loss of balance. The child was running across the grassy area near the concrete walkway when they lost their balance and fell, striking their forehead on the concrete walkway.

Staff were quick to attend to the child, first aide was rendered via ice pack, the facility followed their operational plan and emergency plan, contacted the parent, and provided a documented incident report. Per facility staff, the child was seen by a medical professional as a precaution and cleared for return for the following day. The child returned to the facility on 08/20/2026 without medical restrictions.

At time of this visit LPA conducted interviews with pertinent individuals, reviewed facility documents and made direct observations of the outdoor play space where the incident occurred. LPA did not observe any obstructions or hazards in the outdoor play area where the incident occurred.

Gilbert Sena
Justin Giese
DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2026
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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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: SBCUSD-HIGHLAND-PACIFIC PRESCHOOL
FACILITY NUMBER: 364846577
VISIT DATE: 08/20/2026
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Based on observation and interview, it appears the incident was accidental in nature. Staff observed the child lose their balance while running and fall, first aide was rendered and the incident was reported to all parties appropriately. No deficiencies have been cited during todays inspection and incident follow-up

Exit interview conducted and this report was reviewed with Permit Teacher, Kelly Fruchey

A notice of site visit was given and must remain posted on for the next 30 days.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Justin Giese
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC809 (FAS) - (06/04)
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