<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300842
Report Date: 08/07/2025
Date Signed: 08/07/2025 01:11:47 PM

Document Has Been Signed on 08/07/2025 01:11 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:THREE LITTLE OWLS LEARNING ACADEMY, INCFACILITY NUMBER:
376300842
ADMINISTRATOR/
DIRECTOR:		CLAUDIA BARLEYFACILITY TYPE:
860
ADDRESS:770 SYCAMORE AVE. UNITS A-DTELEPHONE:
(858) 705-9138
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 85TOTAL ENROLLED CHILDREN: 16CENSUS: 16DATE:
08/07/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Maliha Edirisavifeyah, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On August 7, 2025, at 12:00 PM, Licensing Program Analysts (LPA's) Griselda Castellon and William Chancellor conducted Case Management visit separate from a inspection regarding a capacity change for the infant and preschool program. During the tour of the facility, LPA’s observed safe sleep violations.

LPA's observed one child (C1) in a crib, without a fitted sheet. Additionally, a second child (C2) was observed in a crib to be utilizing a sleep sack without a medical waiver and a pacifier attached to the sleep sack with a clip. C2 was observed to be napping on their side, without the Individual Sleep Plan (LIC9227) updated from parent to reflect that C2 can independently roll over from their back to their side, and from their side to their back. Sleep logs reflect C2 napping on their side this entire week.

See LIC 809D for cited deficiency.

An exit interview was conducted, and this report was reviewed with Licensee (LIC) Maliha Edirisavifeyah. Appeal rights were discussed and provided during the exit interview. A notice of site visit was given and must remain posted for 30 consecutive days.

NAME OF LICENSING PROGRAM MANAGER: Pauline Beschorner
NAME OF LICENSING PROGRAM ANALYST: William M Chancellor Jr.
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2025
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 3
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)
Page: 2 of 3
Document Has Been Signed on 08/07/2025 01:11 PM - It Cannot Be Edited


Created By: William M Chancellor Jr. On 08/07/2025 at 11:49 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: THREE LITTLE OWLS LEARNING ACADEMY, INC
FACILITY NUMBER: 376300842

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2025
Section Cited
CCR
101439.1(f)(1)(A)

1
2
3
4
5
6
7
Infant Care Center Sleeping Equipment
Cribs shall be free from all loose articles and objects, including blankets and pillows. (1) Pacifiers shall be allowed in the crib if the following provisions are in place: (A) There shall not be anything attached to the pacifier.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will email LPA a written decleration of Title 22 Regulation 101439.1. Additionally, Licensee must understand sleep sacks are not permitted in CCC without a medical exemption since they are considered a swaddeling device.
8
9
10
11
12
13
14
LPAs observed C2 utilizing a sleep sack without a medical exception on file. Additionally C2 had a pacifier attached to the sleep sack with a clip while in thecrib napping.
8
9
10
11
12
13
14
Type B
08/15/2025
Section Cited
CCR101429(2)(B)(3)(a)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision for Infants:
(3) Infants up to 12 months of age who are sleeping in a position other than on their back. a. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, staff shall return the infant to their back for sleeping.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will provide update to LIC 9227 for C2 to reflect section C or D if child is rolling over independently. Additionally, License will email a written decleration of understanding for Title 22 Regulation 101429.
8
9
10
11
12
13
14
LPA observed C2 to be napping on their side during inspection. Record review confirmed C2 LIC 9227 was not updated to reflect rolling over and sleep logs documented C2 napping on their side from 8/5-8/7.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Pauline Beschorner
NAME OF LICENSING PROGRAM MANAGER:
William M Chancellor Jr.
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3