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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846083
Report Date: 11/04/2021
Date Signed: 11/05/2021 05:07:40 PM

Document Has Been Signed on 11/05/2021 05:07 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EVERBROOK ACADEMYFACILITY NUMBER:
334846083
ADMINISTRATOR:BRADSHAW, KRISTIEFACILITY TYPE:
830
ADDRESS:14276 SCHLEISMAN RDTELEPHONE:
(951) 272-8700
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
11/04/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:DeAnne McCashland and Tammi RenfroTIME COMPLETED:
04:45 PM
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This is a change of ownership application. Facility is currently operating. Licensing Program Analysts (LPAs) Kim Leung and Elyse Jones conducted a prelicensing inspection at the facility this date on 11/4/2021. Upon arrival, LPAs met with applicant representative DeAnne McCashland and facility director Tammi Renfro. LPA toured proposed Infant center, inside and out. The days and hours of operation will be: Monday through Friday from 6:30am to 6:30pm. Measurements of the indoor and outdoor activity space are on file.

Infant Indoor Activity Areas
LPA has determined that there is sufficient indoor activity space to accommodate the requested capacity.

Infant Bathroom Fixtures
There are 3 sinks and 2 toilets in the Toddler Room and 2 sinks in the Infant Room.

Infant Outdoor Activity Area:
LPA has determined that there is sufficient outdoor activity space to accommodate the requested capacity.

Limiting factor for infant capacity is indoor and outdoor activity space. Infant capacity is limited to 24 children.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment.
· There are changing tables within arm’s reach of sinks in each of the activity rooms
· Drinking water is provided by use of Brita, disposable cups, sippy cups and infant bottles
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 334846083
VISIT DATE: 11/04/2021
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· Playground is enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· 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.
· An adequate amount of cushioning material (rubber filler) is in place under play equipment
· Adequate shade is provided by the shade structure
· Kitchen is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies. However, at this time hot water is not immediately available at the sink. Applicant and director agreed to resolve the issue and make running immediately hot water available in the kitchen. Each activity room has a refrigerator for storage of infant formula, and food.
· The office area is located at the front and will serve as the isolation area for ill children temporarily until parents arrive
· The office area is located at the front and will serve as the isolation area for ill children temporarily until parents arrive
· The ladies' bathroom in the hallway is also used as the isolation bathroom and is conveniently located to the isolation area
· The applicant states that they plan to provide Incidental Medical Services (IMS) at this time. A written plan including IMS is required.
· First Aid kit is complete
· Electronic sign in/out that each of the authorized representatives is assigned a unique PIN for checking in and out children. Facility uses paper sign in/out in at the same time.
· The applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Needs and Services plans were reviewed and discussed and must be updated at least quarterly or whenever needed.
· There are sufficient cribs and/or cots for each child.
· There is a separate napping area
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 334846083
VISIT DATE: 11/04/2021
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· Applicant and director agreed to logon Guardian to associate all staff members to this application.
· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
· The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be posted for 30 days.
The following was also reviewed and discussed:
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: EVERBROOK ACADEMY
FACILITY NUMBER: 334846083
VISIT DATE: 11/04/2021
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Updated information was provided to the applicant on LIC809 Facility Evaluation Report dated 11/5/2021 for the preschool program, facility #334846082.

An exit interview was conducted and during the interview, facility director Tammi Renfro confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The following items need to be completed/corrected prior to a license being issued:

1. Submit LIC401 Monthly Operating Statement to include budget for First Aid supplies and fee to renew the license.
2. Submit in-service training calendar for the first year of operation with topics.
3. Facility sketch with names of each room and location of the playground.
4. Plan of operation to include incidental medical Services (IMS).
5. Make running immediately hot water available in the kitchen.

A fire clearance is on file. Once the correction has been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 24 infants, ages 6 weeks to 24 months. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. An exit interview was conducted and a copy of this report was provided to the applicant on this date.

COVID-19 RAST (Rapid Assistance Support Team) inspection was conducted this date during the same visit. Self-Assessment on file.

A copy of this report must be made available to the public for 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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