334846096-9-30-2021-09-CC-KLEG-C7CQ4N-20210930115037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846096
Report Date: 09/29/2021
Date Signed: 09/30/2021 11:50:49 AM

Document Has Been Signed on 09/30/2021 11:50 AM - 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:	GREEN RIVER MONTESSORI		FACILITY NUMBER:	334846096
ADMINISTRATOR:	ZHANG, XIAN		FACILITY TYPE:	840
ADDRESS:	2791 GREEN RIVER, SUITE 112		TELEPHONE:	(949) 291-6662
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY: 11	TOTAL ENROLLED CHILDREN: 0	CENSUS: 8	DATE:	09/29/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:35 PM
MET WITH:	Xian Zhang, Sapna Sachdev, Robert O'Conner		TIME COMPLETED:	06:45 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	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 9/29/2021. Upon arrival, LPAs met with applicant Xian Zhang, facility director Sapna Sachdev and applicant's consult Robert O'Conner. LPA toured proposed Preschool center, inside and out. The days and hours of operation will be: Monday through Friday from 6:00am to 6:30pm. Measurements of the indoor and outdoor activity space are on file. Indoor Activity Areas LPA has determined that there is sufficient space to accommodate 11 children, the requested capacity. Bathroom Fixtures One toilet x 15 = 15 children One sink x 15 = 15 children Outdoor Activity Area: LPA has determined that there is sufficient space to accommodate 11 children. Applicant has requested for a waiver to allow shared use of the playground with preschool children on an alternate schedule. Limiting factor for preschool capacity is Bathroom fixtures. School-age capacity is limited to 11 children.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 5

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: GREEN RIVER MONTESSORI	FACILITY NUMBER: 334846096
	VISIT DATE: 09/29/2021

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
26
27
28
29
30
31
32

The following was observed:
· Classroom is adequately equipped with age and size appropriate furniture and equipment
· The drinking faucets in activity rooms and on playground supply drinking water. During the COVID-19 pandemic, the facility is providing drinking water by using water bottles. The bottles are filled up by staff throughout the day.
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· There are no accessible bodies of water present at this time. Applicant and director understand that 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 and around the high climbing play equipment
· Adequate shade is provided by shade structure. There is a shaded area in the patio.
· Kitchen is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies. No cooking is required as facility only serves ready-to-eat snacks.
· The office area is located at the front and will serve as the isolation area for ill children temporarily until parents arrive
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area
· Medications will be stored in the kitchen and will be secured in a locked box
· The applicant states that they plan to provide Incidental Medical Services (IMS) at this time. A written plan for IMS is on file.
· First Aid kit is complete
· Electronic sign in/out. Applicant agreed to use paper sign in/out in case of power outage or system malfunctions.
· Component II Orientation was completed during this inspection
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov, and

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: GREEN RIVER MONTESSORI	FACILITY NUMBER: 334846096
	VISIT DATE: 09/29/2021

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
26
27
28
29
30
31
32

· A review of staff records on 9/29/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
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 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 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: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: GREEN RIVER MONTESSORI	FACILITY NUMBER: 334846096
	VISIT DATE: 09/29/2021

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
26
27
28
29
30
31
32

Updated child care information was provided to the applicant on LIC809 Facility Evaluation Report dated 9/29/2021 for the preschool program, facility #334846095.

v This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that the Department add instruction on the prevention of lead exposure to the Preventative Health and Safety Training curriculum for providers licensed on or after July 1, 2020. Finally, it 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. The Department must adopt regulations in consultation with the State Water Resources Control Board for the implementation of the requirements for the testing of drinking water for lead in Child Care Centers by January 1, 2021. The regulations shall include requirements to ensure the collection and submission of valid water samples.

An exit interview was conducted and during the interview, the applicant Xian Zhang 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. Proof of completion of preventative health and safety training including childhood nutrition and prevention of lead exposure
2. In-service training plan to include all required training
3. LIC401 Monthly Operating Statement for the school-age program only
4. Secure the spider climber into the ground
5. Clean and sanitize all playground furniture
6. Escrow closing statement.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Kim Leung
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: GREEN RIVER MONTESSORI	FACILITY NUMBER: 334846096
	VISIT DATE: 09/29/2021

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
26
27
28
29
30
31
32

A fire clearance has been obtained. Once all corrections have been made, with proof sent to licensing, and the required documents have been received, the application will be submitted for approval with a maximum capacity of 11 children, 6 to 12 years of age. 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: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5