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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300358
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:25:18 PM

Document Has Been Signed on 11/26/2024 01:25 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:COLES COTTAGE ACADEMYFACILITY NUMBER:
376300358
ADMINISTRATOR/
DIRECTOR:		COSTA,WEERATUNGAFACILITY TYPE:
850
ADDRESS:505 CIVIC CENTER DRTELEPHONE:
(949) 836-4465
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 13DATE:
11/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:37 AM
MET WITH:Gabby Adame- Facility RepresentativeTIME VISIT/
INSPECTION COMPLETED:
11:48 AM
NARRATIVE
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 Licensing Program Analyst (LPA) Kelly Gerth conducted a case management visit on this date to address an issue separate from the initial unannounced case management visit to the facility.

During the visit on this date, LPA Gerth observed that the Facility Director was not on site and per the Facility Representative, Gabby Adame, a Director is not scheduled on-site full-time hours. Although Ms. Gabby Adame stated that the Director is not present today due to unforeseen circumstances, the Director is also not present at the facility, during full time hours of operation.

See LIC809D for cited deficiencies of the California Code of Regulations, Title 22, Div. 12.

An exit interview was conducted. The appeal rights were discussed and provided along with a copy of this report to Facility Representative Gabby Adame, on this date. A Notice of Site Visit was posted.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 11/26/2024 01:25 PM - It Cannot Be Edited


Created By: Kelly Gerth On 11/26/2024 at 11:07 AM
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: COLES COTTAGE ACADEMY
FACILITY NUMBER: 376300358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2024
Section Cited
CCR
101215.1(b)

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101215.1 Child Care Center Directors Qualifications and Duties(b) All child care centers shall have a director.
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By Close of Business (COB), Licensee will submit proof to CCLD, that a fully qualified director is present at the facility at least 80% of the time.
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This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above, where LPA confirmed that the facility does not have a full-time, fully qualified director on site during operating hours, instead 2 staff rotate days/scheduling on site as a Director each week. One staff member is the Owner, and one staff member is employed as an Office Assistant.
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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:Carlos Martinez
LICENSING EVALUATOR NAME:Kelly Gerth
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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