336300588-8-18-2022-10-CC-ANOE-CHENVR-20220818104824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336300588
Report Date: 08/18/2022
Date Signed: 08/18/2022 10:50:14 AM

Document Has Been Signed on 08/18/2022 10:50 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	RIDGE CREST ELEMENTARY PRESCHOOL		FACILITY NUMBER:	336300588
ADMINISTRATOR:	ADCOCK, JENNIFER		FACILITY TYPE:	850
ADDRESS:	28500 JOHN F. KENNEDY DR.		TELEPHONE:	(951) 571-4716
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 0	DATE:	08/18/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Jennifer Adcock		TIME COMPLETED:	11:15 AM

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	Licensing Program Analyst (LPA), Ana Noble conducted a pre-licensing inspection this date for a proposed Preschool Program. The days and hours of operation will be: Monday - Friday 8:00 am to 4:00 pm. LPA met with Jennifer Adcock, who led a tour of the facility at 9:25 AM. The facility was toured inside and out, and the following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · Drink fountain with disposable cups, supply drinking water in the indoor activity space · Playground is enclosed by a chain link fence · The Outdoor activity area is supplied with equipment which Licensee will submit documentation to verify if age appropriate. If NOT age appropriate the Licensee will create a barricade to prevent the children from having access to that equipment during outdoor play time. Pictures will submitted to the department if barricading the equipment (only if equipment is not age appropriate). · There are no accessible bodies of water present. If wading pools or similar products are used, they must be emptied immediately after use and stored in an upright position. · An adequate amount of cushioning material-rubber padding is in place under play equipment · Adequate shade is provided by canopy. · Drinking water is provided in the outdoor play area by pitchers and disposable cups · Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies-Meals are prepared by the school district cafeteria. · The office area is located near the entrance · Teacher's desk or nurses office will serve as the isolation area for ill children temporarily until parents arrive · There is a working telephone located in the facility. · Medication will be stored in the upper cabinet above the sink in the classroom which is inaccessible to children in locked cabinet. · Storage area for toxins and poisons is locked, located in a storage area on the elementary school campus.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RIDGE CREST ELEMENTARY PRESCHOOL	FACILITY NUMBER: 336300588
	VISIT DATE: 08/18/2022

NARRATIVE

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· Medication administration forms were reviewed
· First Aid kit is complete with all the required items at this time.
· Sign in/Sign out record was reviewed and meets regulation requirements
· Parent Board located near the entrance with all required forms.
· Carbon Monoxide Detector located near the cabinet next to the drinking fountain.

Measurements were taken and the following was determined:

Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 22 children.

School-age Bathroom Fixtures
2 toilets x 15 = 30 children
2 sinks x 15 = 30 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 212 children.
A waiver for sharing playground/outdoor activity space is pending approval.

Limiting factor for Preschool capacity is limited to 22 children. The Fire Clearance was granted on 7/26/2022.

During the inspection, the following was reviewed with Facility Representative Jennifer Adcock:
· Component II Orientation was completed
· The applicant was informed of their reporting requirements and provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The importance of checking for recalled infant (children) devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant (children) devices with the CPSC to be notified of any recalls on their purchased equipment.

· Provider Information Notice (PIN) 22-20-CCP: Resources and Requirements on Lead Testing in Child Care

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RIDGE CREST ELEMENTARY PRESCHOOL	FACILITY NUMBER: 336300588
	VISIT DATE: 08/18/2022

NARRATIVE

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· LPA reviewed Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department if the facility will provide the services. 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
· The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 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.

A review of staff records on 8/15/2022 indicates that the applicant and/or designated individual who is required to have caregiver background checks have received criminal record and child abuse index clearances or exemptions. The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

LPA reviewed with Facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: RIDGE CREST ELEMENTARY PRESCHOOL	FACILITY NUMBER: 336300588
	VISIT DATE: 08/18/2022

NARRATIVE

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

1. Shared playground waiver needs to be approval.
2. Verification of the age group use of the outdoor play structure (slide) or pictures of the barricade that was installed to prevent children from having access to the play structure.

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 22. As agreed upon by facility representative Jennifer Adcock-Principal, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. Exit interview conducted and report was reviewed with Facility representative.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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