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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300213
Report Date: 04/24/2023
Date Signed: 04/24/2023 01:10:33 PM

Document Has Been Signed on 04/24/2023 01:10 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BUDS AND BLOSSOMS PRESCHOOLFACILITY NUMBER:
376300213
ADMINISTRATOR:NIKKI BOLESFACILITY TYPE:
850
ADDRESS:2809 S MISSION RDTELEPHONE:
(760) 645-3044
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 38DATE:
04/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nikki BolesTIME COMPLETED:
01:30 PM
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On 4/24/23 Licensing Program Analyst (LPA) William Chancellor and Ana Nobel along with Licensing Program Manager (LPM) Pauline Beschorner and Deborah Mullen arrived to provide a case management- plan of correction visit.
LPA's and LPM's met with Nikki Boles shared the purpose of the visit and provided inspections to measure both preschool classrooms and playground, due to changes made by the Licensee to use the playgrounds and classrooms.

The following plan's of corrections are due and have yet to be submitted.
1. Due 5/11/23: submit a request for a waiver to utilize the preschool playground for the toddlers.
2. Due 4/28/23: Licensee will provide a email copy of immunization records for staff 4.
3. Due 4/28: Licensee will email a copy of proof of negative TB test to LPA Chancellor.
4. Due 4/28/23: Submit a photo of wood chips being resorted to the dug out holes under the hammocks.

All other plans of corrections have been submitted and approved.

There are no deficiencies being cited at this time.

An exit interview was conducted, and this report was reviewed with the licensee Nikki Boles. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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