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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845644
Report Date: 12/18/2023
Date Signed: 12/18/2023 04:48:57 PM

Document Has Been Signed on 12/18/2023 04:48 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINGSTON ACADEMYFACILITY NUMBER:
334845644
ADMINISTRATOR:KAREN BRAZZILLFACILITY TYPE:
850
ADDRESS:6048 ETIWANDA AVENUETELEPHONE:
(951) 681-4182
CITY:MIRA LOMASTATE: CAZIP CODE:
91752
CAPACITY: 72TOTAL ENROLLED CHILDREN: 34CENSUS: 16DATE:
12/18/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Karen BrazzillTIME COMPLETED:
04:50 PM
NARRATIVE
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On 12/18/2023 at Susan Brewer Licensing Program Analysts (LPAs) Susan Brewer and Aman Sharma, arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Director Karen Brazzill. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following:

Normal days and hours of operation are: Monday- Friday, 6:00 AM – 6:00 PM, in Preschool classrooms 2, 3 and 5.

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements
Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and
Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility
The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 12/18/2023
NARRATIVE
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· The facility is operating within the terms of the license.
· Ratios were met and appropriate supervision was provided during this inspection with 16 children supervised by 4 staff.
· Classrooms are clean, free of hazards and equipped with age-appropriate furniture and equipment in good condition.
· No weapons stored at the facility.
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· No medications are stored at the facility, the licensee does not provide IMS services.
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are locked.
· All floors are clean and safe.
· Bathrooms were observed to be safe and in operating condition, however during the inspection at LPA Susan Brewer observed the preschool toilets to be dirty an unsanitary from.
· Outdoor activity areas/playgrounds are enclosed by appropriate fences, and are supplied with age and size appropriate equipment in good condition, however the outdoor activity area is NOT free of hazards. At 10:52 AM LPAs observed a wooden pallet propped against a damaged metal wall panel of a storage shed to make inaccessible in the outdoor activity area, however the panel and pallet are not secured. Also observed in the outdoor play area were roles, 1 of 3 bags of steer manure open and exposed, 4 roles of chicken wire fencing and metal pins left outside the exit doors and accessible from the outdoor play area.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin.
· Measures are taken to keep the facility free of flies, other insects and rodents.
· Food is stored appropriately and protected from contamination.
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair.
· Menus are posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· Drinking water shall be readily available both indoors and out and provided by sippy cups, water fountains, however the LPAs were unable to determine if the drinking water is uncontaminated. The licensee stated, they have not conducted testing for lead on the water outlets used for consumption and food preparation.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
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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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 12/18/2023
NARRATIVE
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· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has rubber chips and natural grass.
· Sign in/Sign out record was reviewed and meets regulation requirements. The facility uses Bright wheel app.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 04/03/2025.
· Opening and closing staff member’s CPR/First Aid expires on 12/2024
· Director completed Health and Safety Training on Fall 1998 transcripts, No Lead.
· Staff qualifications and files were reviewed and are NOT complete: a staff member present is missing their 2 staff present are missing the LIC503 Health Screening, 1 staff present is missing the Immunization records.
· Staff have received on the job training for housekeeping, sanitation and universal health precautions,
Licensee was informed the Department has inspection authority per Health and Safety Codes.
Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
· Children files were reviewed and are NOT complete on today's date: 1 child is missing proof of immunization records and 2 children missing LIC701 Physicians reports.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill 04/2023 however the licensee conducted a drill on 12/18/2023 during the inspection.
· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644
VISIT DATE: 12/18/2023
NARRATIVE
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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Facility Director Karen Brazzill, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs informed Director Karen Brazzill, of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Citations issued for Type B violations on today's date.

No civil penalties issued on 12/18/2023.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Director Karen Brazzill.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/18/2023 04:48 PM - It Cannot Be Edited


Created By: Susan Brewer On 12/18/2023 at 03:45 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above the licensee failed to have water outlets used by children and staff for food preparation and water consumption prior to Jan 1 2023, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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The licensee agrees to provide proof of scheduling to have the child care center drinking water tested for lead contamination levels on all water outlets used for water consumption and/or food preparation, as defined in Health and Safety Section 1596.76 and every five years after the date of the initial test and submit proof of the scheduled date with an approved vendor by 01/19/2024, as instructed in PIN 21-21.1 CCP and submit required documentation and reported results to the department by fax, mail or e-mail.
Type B
Section Cited
CCR
101238.2(c)
Outdoor Activity Space
(c) Equipment and activity areas shall be arranged so that there is no hazard from conflicting activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in at 10:52 AM LPAs observed a unsecured wooden pallet propped against a damaged metal wall panel of a storage shed located in the outdoor activity area, 1 of 3 bags of steer manure open, 4 roles of chicken wire fencing and metal pins left outside the exit doors and accessible from the outdoor play area which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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The licensee agrees to submit a plan to make the damaged shed, gardening and landscaping materials inaccessible to daycare children and submit proof of correction to the departement on or before 01/19/2024 by fax, mail or e-mail.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/18/2023 04:48 PM - It Cannot Be Edited


Created By: Susan Brewer On 12/18/2023 at 03:45 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 staff present are missing the LIC503 Health Screening and 1 staff present is missing the immunization records, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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The licensee agrees to submit proof of LIC503 Health Screening for 2 staff and immunization records for 1 staff on or before 01/19/2024, by fax, mail or e-mail.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure 1 child present and in care has proof of medical assessment LIC701, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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The licensee agrees to ensure all children enrolled, prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child and provide proof of a medical assessment for a subject child on or before 01/19/2024.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 12/18/2023 04:48 PM - It Cannot Be Edited


Created By: Susan Brewer On 12/18/2023 at 03:45 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINGSTON ACADEMY
FACILITY NUMBER: 334845644

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure a child present and in care has received the required immunizations and failed to maintain proof of immunizations for the subject child which posesd a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/29/2023
Plan of Correction
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The licensee to ensure documention is obtained in each child's file for immunizations and shall maintain such documentation in the center for as long as the child/(ren) is enrolled. The licensee also agrees to submit proof of documentation for a subject child to the department on or before 12/29/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


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