334845704-10-3-2025-09-CC-TDIP-DM4RP3-20251003131116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334845704
Report Date: 10/03/2025
Date Signed: 10/03/2025 01:11:39 PM

Document Has Been Signed on 10/03/2025 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	JUSD SKY COUNTRY ELEMENTARY PRESCHOOL		FACILITY NUMBER:	334845704
ADMINISTRATOR/ DIRECTOR:	TRACI PAYO		FACILITY TYPE:	850
ADDRESS:	5520 LUCRETIA AVENUE		TELEPHONE:	(951) 222-7850
CITY:	JURUPA VALLEY	STATE: CA	ZIP CODE:	91752
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 28	DATE:	10/03/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Cheryl Mitchell		TIME 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 10/03/2025 at 9:45 AM, Licensing Program Analyst (LPA) Tiffanie Diep arrived at the facility to conduct an annual inspection. LPA toured the facility inside and out, records were reviewed, and the following was observed and/or discussed: · This is not a combination center. · Normal days and hours of operation are Monday through Friday from 8:00 AM to 2:30 PM for Rooms 26 and 27 and Monday through Friday from 8:00 AM to 11:00 AM and from 12:00 PM to 3:00 PM for Room 28. · A review of staff and children's records was conducted as part of this evaluation. · The facility was operating with the limits as stated on the license. · Ratios were being met during the inspection. · Classrooms were adequately equipped with age and size-appropriate furniture and equipment and free of hazards. · There are no weapons present at the facility per Facility Representative Cheryl Mitchell. · Facility Representative confirmed there are no accessible bodies of water present at this time. All wading pools or similar products must be emptied immediately after use. LPA referred Facility Representative to the Department website for new pool safety requirements effective January 1, 2025: Child Care Provider Webinar 2024 Q4 and PIN 25-01-CCP. · Children bring their own water bottles to the facility. · Water testing for lead contamination was completed on 10/15/2022. · There are no children currently enrolled that have any prescribed medication per Facility Representative. Continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Tiffanie Diep
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

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: JUSD SKY COUNTRY ELEMENTARY PRESCHOOL	FACILITY NUMBER: 334845704
	VISIT DATE: 10/03/2025

NARRATIVE

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Continued from LIC 809 (Page 2)

· All hazardous items, such as disinfectants, cleaning solutions, and other items that could pose a danger were stored inaccessible to children.
· Toxins were locked.
· All floors were observed to be clean and safe.
· Restrooms were observed to be safe, sanitary, and in operating condition.
· Outdoor activity areas were supplied with age and size-appropriate equipment in good condition.
· Playgrounds were enclosed by appropriate fences and free of hazards.
· Food preparation area was clean, free of litter, rubbish, and free of rodents and other vermin.
· Food was stored appropriately and protected from contamination.
· All storage containers for solid waste, including moveable bins, had tight-fitting covers that were kept on and in good repair.
· Menus were posted at least one week in advance in a place visible by the child’s authorized representative, dated, kept on file for 30 days, and made available upon request.
· The program currently shares the play area with Kindergarten and Transitional Kindergarten with an approved waiver.
· The areas around or under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs a fall, which was rubber mats.
· Sign-in/out records were reviewed and met regulation requirements.
· Children’s records were complete.
· Staff records reviewed during today’s inspection indicate that all facility staff or other individuals who require caregiver background checks have received all required clearances or exemptions and meet minimum qualifications for the position for which they were hired.
· A staff member was present with current pediatric CPR certification which expires on 10/26/2026. LPA informed Facility Representative that both CPR and first aid certifications are to be pediatric and approved by EMSA.
· Documentation of fire and disaster drills was on file; last drills were conducted on 09/25/2025 and 09/29/2025.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Tiffanie Diep
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD SKY COUNTRY ELEMENTARY PRESCHOOL	FACILITY NUMBER: 334845704
	VISIT DATE: 10/03/2025

NARRATIVE

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Continued from LIC 809-C (Page 3)

· Facility Representative was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting e-mail at UnusualIncidentReportsDO09@dss.ca.gov.
· Facility Representative can submit transfer forms to associate new individuals or to disassociate someone from the facility via e-mail to Associations_Disassociations862@dss.ca.gov.
· The Duty Officer is available to answer questions Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200.

The following items were posted and updated where necessary:
· License
· Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148)
· Notification of Parents' Rights poster (PUB 393)
· Personal Rights (LIC 613A)
· California Child Passenger Safety Law (PUB 269)
· Menu

The facility representative is asked to update the following documents, if applicable, and submit to Licensing within 30 days:
1. Designation of Facility Responsibility (LIC 308) (only if changes have been made)
2. Administrative Organization (LIC 309) (only if changes have been made)
3. Personnel Report (LIC 500)
4. Emergency Disaster Plan (LIC 610)
5. Parent Handbook/Program Curriculum/Admission policies and procedures/Fee schedule (only if changes have been made)

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Tiffanie Diep
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD SKY COUNTRY ELEMENTARY PRESCHOOL	FACILITY NUMBER: 334845704
	VISIT DATE: 10/03/2025

NARRATIVE

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Continued from LIC 809-C (Page 4)

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every five years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries 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/inspection-process. Facility Representative was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There were no deficiencies cited at this time. See attached LIC 9102 for advisory note. An exit interview was conducted and report was reviewed with the facility representative, Cheryl Mitchell. A notice of site visit was given to Facility Representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Tiffanie Diep
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

LIC809 (FAS) - (06/04)

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