336300727-7-26-2023-10-CC-ANOE-CU4SWR-20230726141446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336300727
Report Date: 07/26/2023
Date Signed: 07/26/2023 02:14:53 PM

Document Has Been Signed on 07/26/2023 02:14 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	TEMECULA MONTESSORI ACADEMY - INFANT		FACILITY NUMBER:	336300727
ADMINISTRATOR:	XING,ZHOU		FACILITY TYPE:	830
ADDRESS:	27635 JEFFERSON AVENUE		TELEPHONE:	(951) 676-6464
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92590
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/26/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:31 AM
MET WITH:	Zhou Xing		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA), Ana Noble conducted a pre-licensing inspection this date for a proposed lnfant. The days and hours of operation will be: Monday-Friday 7:00 am - 6:00 pm. LPA met with Zhou Xing who led a tour of the facility at 10:00 AM. Also toured was the Preschool Program. The facility was toured inside and out, and the following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · Children's own water dispenser brought from home and tap water, supply drinking water in the indoor activity space. · Playground is enclosed by a 4 ft wrought iron fence · Outdoor activity area is supplied with age and size appropriate equipment · 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 sand in place under play equipment · Adequate shade is provided by patio cover. · Drinking water is provided in the outdoor play area by children's own water dispensers and filled before going outdoors. · Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils, and adequate amount of food supplies · The office area is located inside the infant classroom. · Director office will serve as the isolation area for ill children temporarily until parents arrive · There is a working telephone located in the facility.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: TEMECULA MONTESSORI ACADEMY - INFANT	FACILITY NUMBER: 336300727
	VISIT DATE: 07/26/2023

NARRATIVE

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·Medication will be stored in the locked box in classrooms which is inaccessible to children.
· Storage area for toxins and poisons is locked, located in upstairs in a locked storage room.
· Medication administration forms were reviewed
· First Aid kit is complete with all of the required items.
· Sign in/Sign out record was reviewed and meets regulation requirements
· Parent Board located in the lobby with all required forms.
· Carbon Monoxide Detector located Preschool Classroom.

Measurements were taken and the following was determined:

Preschool Indoor Activity Areas-
LPA has determined that there is sufficient space to accommodate 60 children.

Bathroom Fixtures
3 toilets/1Urinal x 15 = 60 children
4 sinks x 15 = 60 children

Playground Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 72 children.
A waiver for sharing playground/outdoor activity space is pending approval.

Limiting factor for Preschool capacity is Indoor Space. The Fire Clearance was granted on July 11, 2023. Preschool capacity is limited to 60 children.

During the inspection, the following was reviewed with Applicant:
· 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

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: TEMECULA MONTESSORI ACADEMY - INFANT	FACILITY NUMBER: 336300727
	VISIT DATE: 07/26/2023

NARRATIVE

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·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

· 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.

Applicant 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 7/19/2023 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

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: TEMECULA MONTESSORI ACADEMY - INFANT	FACILITY NUMBER: 336300727
	VISIT DATE: 07/26/2023

NARRATIVE

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LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.
LPA reviewed with Applicant 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.

The following items need to be completed/corrected prior to a license being issued: 1. Waiver for shared playground. 2. Proof of close of escrow, submit documentation

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 60 Children. As agreed upon by Applicant, Zhou Xing, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

If all corrections are approved and facility licensed, you must have the drinking water outlets used for drinking and cooking tested for lead and post the results within 180 days of licensure. Exit interview conducted and report was reviewed with Applicant, Zhou Xing.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC809 (FAS) - (06/04)

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